Posterior Arm Shoulder Dystocia Alleviated by the Zavanelli Maneuver

The exact role of the Zavanelli maneuver for the management of shoulder dystocia still remains to be defined. None of the previously reported cases in which the Zavanelli maneuver has been employed described impaction of posterior fetal arm. At 40 weeks' gestation, a nulliparous patient with gestational diabetes, who underwent vacuum delivery, delivered an infant with shoulder dystocia. McRoberts' maneuver, suprapubic pressure, midline episiotomy, and Woods' maneuver were all unsuccessful in alleviating the shoulder dystocia. The posterior fetal arm was noted to be persistently impacted, so the Zavanelli maneuver was used to deliver an unsuspected macrosomic (4215 g) infant. The newborn, at the age of 3 years, has a right Erb's palsy. The Zavanelli maneuver can be used to alleviate a posterior arm shoulder dystocia, though there may be concomitant neurological injury.