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Abdominal Access for Shoulder Dystocia as a Last Resort - a Case Report
A Enekwe1, R Rothmund2, B Uhl1
1Gynaecology Deparment, St-Vinzenz-Hospital Dinslaken, Dinslaken, Germany.
Geburtshilfe Und Frauenheilkunde
|September 30, 2014
Summary
Shoulder dystocia, a delivery complication, requires advanced interventions when standard maneuvers fail. This case highlights successful delivery via laparotomy and specific maneuvers for severe shoulder dystocia.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Shoulder dystocia is an unpredictable intrapartum emergency.
- Risk factors include maternal obesity and labor induction.
- Standard maneuvers (e.g., McRoberts) may be insufficient.
Purpose of the Study:
- To report a severe case of shoulder dystocia.
- To describe the management of a complex shoulder dystocia case.
- To emphasize the need for advanced operative skills.
Main Methods:
- Case report of severe shoulder dystocia.
- Unsuccessful attempts with McRoberts and internal rotation maneuvers.
- Emergency laparotomy, uterotomy, Woods screw maneuver, and direct suprapubic pressure.
Main Results:
- Successful delivery achieved after laparotomy and combined maneuvers.
- Newborn required postpartum resuscitation and ventilation but recovered.
- Erb's palsy of the posterior arm showed improvement.
Conclusions:
- Severe shoulder dystocia may necessitate operative interventions beyond vaginal maneuvers.
- Training in operative maneuvers is crucial for birth attendants.
- Risk management and preparedness are recommended for obstetric clinics.
