Abdominal rescue after failed cephalic replacement

Area of Science:

• Obstetrics and Gynecology
• Surgical Management

Background:

• Shoulder dystocia management lacks established protocols for failed cephalic replacement.
• Cephalic replacement is a known technique, but its limitations require further investigation.

Observation:

• A case of severe shoulder dystocia in a nulliparous woman with a macrosomic infant is presented.
• Standard maneuvers and cephalic replacement failed, necessitating an alternative intervention.
• Abdominal hysterotomy with a low transverse uterine incision was performed.

Findings:

• The hysterotomy facilitated manual rotation of the fetal shoulder.
• This maneuver allowed for the successful delivery of the posterior arm and infant.
• Abdominal hysterotomy proved effective in resolving intractable shoulder dystocia.

Implications:

• Abdominal hysterotomy is a viable alternative for managing failed cephalic replacement in shoulder dystocia.
• This technique may be particularly useful in cases of persistent failure, especially post-general anesthesia.
• Further research into hysterotomy for shoulder dystocia is warranted to establish its role in obstetric practice.