Hysterotomy to effect vaginal delivery with mentum anterior head entrapment.
BACKGROUND
Entrapment of the aftercoming head after mentum anterior rotation is a life-threatening complication of vaginal breech delivery. Few options exist when rotation and flexion from this position cannot be performed successfully either transabdominally or with vaginal maneuvers.


METHODS
A term primigravida presented with a singleton breech in advanced labor. The fetal torso and arms delivered vaginally, but the aftercoming head became extended and was entrapped in a mentum anterior position. The fetal head could not be rotated and flexed, either vaginally or transabdominally with suprapubic pressure. Laparotomy and hysterotomy were performed, and vaginal delivery of a live fetus was accomplished after rotation and flexion of the fetal head through this incision.


CONCLUSIONS
Hysterotomy is a safe and effective maneuver for delivery of the entrapped fetal head with mentum anterior rotation after standard procedures have failed.
Pollard
J K
JK
Department of Obstetrics and Gynecology, University of Vermont, Burlington, USA.
Leaphart
W L
WL
Braun
T E
TE
Capeless
E L
EL
D000293:Adolescent; D001946:Breech Presentation; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy; D011247:Pregnancy; D014599:Uterus / Q000601:surgery*