Modified Zavanelli maneuver for the alleviation of shoulder dystocia.
BACKGROUND
The Zavanelli maneuver has typically been instituted when conventional maneuvers have failed to alleviate shoulder dystocia. Previously reported cases involving the Zavanelli maneuver have described cephalic replacement followed by immediate cesarean delivery.


METHODS
We encountered a case in which, despite the McRoberts maneuver, suprapubic pressure, Wood's corkscrew manuever, and attempted extraction of the posterior fetal arm, the baby could not be delivered. The fetal vertex was partially reinserted into the vagina, and this dislodged the impacted shoulders. With expulsive efforts the mother was then able to achieve vaginal delivery of a 3870 g female infant.


CONCLUSIONS
The modified Zavanelli maneuver may be used to successfully alleviate shoulder dystocia.
Zelig
Craig M
CM
Department of Obstetrics and Gynecology, United States Naval Hospital Guam, United States Territory, Guam, USA.
Gherman
Robert B
RB
D020516:Brachial Plexus Neuropathies / Q000209:etiology; D004420:Dystocia / Q000628:therapy*; D005113:Extraction, Obstetrical / Q000379:methods*; D005260:Female; D006801:Humans; D010246:Paralysis, Obstetric / Q000209:etiology; D011247:Pregnancy