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Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report

BACKGROUND: Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed...

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Autores principales: Kwan, Angel Hoi Wan, Hui, Annie Shuk Yi, Lee, Jacqueline Ho Sze, Leung, Tak Yeung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489078/
https://www.ncbi.nlm.nih.gov/pubmed/34602052
http://dx.doi.org/10.1186/s12884-021-04126-4
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author Kwan, Angel Hoi Wan
Hui, Annie Shuk Yi
Lee, Jacqueline Ho Sze
Leung, Tak Yeung
author_facet Kwan, Angel Hoi Wan
Hui, Annie Shuk Yi
Lee, Jacqueline Ho Sze
Leung, Tak Yeung
author_sort Kwan, Angel Hoi Wan
collection PubMed
description BACKGROUND: Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. CASE PRESENTATION: A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. CONCLUSIONS: We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-021-04126-4.
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spelling pubmed-84890782021-10-04 Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report Kwan, Angel Hoi Wan Hui, Annie Shuk Yi Lee, Jacqueline Ho Sze Leung, Tak Yeung BMC Pregnancy Childbirth Case Report BACKGROUND: Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. CASE PRESENTATION: A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. CONCLUSIONS: We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-021-04126-4. BioMed Central 2021-10-03 /pmc/articles/PMC8489078/ /pubmed/34602052 http://dx.doi.org/10.1186/s12884-021-04126-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Kwan, Angel Hoi Wan
Hui, Annie Shuk Yi
Lee, Jacqueline Ho Sze
Leung, Tak Yeung
Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_full Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_fullStr Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_full_unstemmed Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_short Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_sort intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489078/
https://www.ncbi.nlm.nih.gov/pubmed/34602052
http://dx.doi.org/10.1186/s12884-021-04126-4
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