The Zavanelli maneuver in two cases of shoulder dystocia

Several reports describe the replacement of the partially delivered fetus into the vagina followed by Cesarean section after failed vaginal delivery. Undeliverable shoulder dystocia is by far the most common cause of failed vaginal delivery. The objective of this report was to review the safety and to reconsider when to perform the Zavanelli maneuver in the management of shoulder dystocia. We report two cases of severe shoulder dystocia in which commonly recommended therapeutic options failed. Cephalic replacement was performed with ease followed by Cesarean section. Endometritis was the maternal complication in both cases. Both infants had transient Erb's palsy. Although traditionally the Zavanelli maneuver is a method of last resort in the management of shoulder dystocia, consideration should be given to its use earlier in the treatment of obstructed vaginal delivery.