Hysterotomy facilitation of the vaginal delivery of the posterior arm in a case of severe shoulder dystocia

Background: Shoulder dystocia is an obstetric emergency that can be resolved usually with one or a series of maneuvers performed vaginally. On rare occasions these maneuvers may fail, and the obstetrician must employ less familiar techniques to achieve delivery. Case: A 30-year-old, gravida 6, developed a severe shoulder dystocia while delivering a 5970 g infant. Classical vaginal maneuvers failed due to the severity of the impaction. After general anesthesia was induced, additional maneuvers such as cephalic replacement and transabdominal rotation also failed. The dystocia was resolved ultimately by a transabdominally-facilitated vaginal posterior arm delivery followed by transabdominal shoulder rotation and vaginal extraction. Conclusion: In catastrophic cases of shoulder dystocia, transabdominal performance or facilitation of traditional vaginal maneuvers may lead to resolution.