Circumferential shoulder laceration after posterior axilla sling traction: a case report of severe shoulder dystocia

Allison R Mccarter,Enid Y Rivera-Chiauzzi,Regan N Theiler

doi:10.1186/s12884-020-03526-2

Abstract

BackgroundShoulder dystocia is an unpredictable and potentially catastrophic complication of vertex vaginal delivery. Posterior axilla sling traction (PAST) has recently been proposed as a method to resolve severe shoulder dystocia when commonly used techniques have failed.Case presentationA 33-year-old woman (gravida 5, para 0) at 35 weeks, 1 day gestation underwent induction of labor for poorly controlled type 2 diabetes mellitus. Delivery of the large-for-gestational-age infant (4,060 g) was complicated by intractable shoulder dystocia, relieved at 3 minutes with PAST, resulting in a deep, circumferential laceration of the fetal posterior shoulder and contralateral phrenic nerve palsy.ConclusionsPAST provides a potentially lifesaving option during intractable shoulder dystocia. Simulation or education about the technique facilitates its use when standard maneuvers fail. It is important to disseminate information about potential complications associated with these novel maneuvers.

Highlights

Shoulder dystocia is an unpredictable and potentially catastrophic complication of vertex vaginal delivery
In most cases, shoulder dystocia occurs in the absence of identifiable risk factors [3, 4]
At approximately 2 minutes and 20 seconds of dystocia time, a 16 French latex urinary catheter was positioned below the posterior fetal shoulder, per the Posterior axilla sling traction (PAST) technique [8]

Summary

Conclusions

PAST provides a potentially lifesaving option during intractable shoulder dystocia. Simulation or education about the technique facilitates its use when standard maneuvers fail. It is important to disseminate information about potential complications associated with these novel maneuvers

Background

Findings

Discussion and conclusions