Cervical neck dislocation associated with the Zavanelli maneuver.
BACKGROUND
In the management of shoulder dystocia, fetal head replacement into the uterus has been advocated should delivery attempts remain unsuccessful. Reports of the Zavanelli maneuver have been remarkably optimistic despite the challenges of the procedure.


METHODS
A gravida 3 para 2 (two previous vaginal deliveries of more than 4,500-g infants) with gestational diabetes presented at term. Following a low forceps delivery, shoulder dystocia was encountered and was unable to be relieved with standard maneuvers. A cesarean delivery was performed, shoulders disimpacted, and the infant delivered abdominally. A 4,680-g stillborn infant was delivered with radiologic and autopsy evidence of cervical C5-C6 dislocation.


CONCLUSIONS
Despite published reports of high success rates and limited fetal consequences, physicians should be aware of adverse consequences including cervical neck trauma associated with use of the Zavanelli maneuver.
Ross
Michael G
MG
Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA. mikeross@ucla.edu
Beall
Marie H
MH
D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects*; D016640:Diabetes, Gestational; D004420:Dystocia / Q000628:therapy*; D017809:Fatal Outcome; D005260:Female; D020567:Fetal Weight; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology*; D019838:Neck Injuries / Q000209:etiology*; D009772:Obstetrical Forceps; D011247:Pregnancy; D012782:Shoulder; D017211:Treatment Failure