Abstract
The Zavanelli manoeuvre is often the final resort of the clinician facing undeliverable
shoulder dystocia and we present retrospective pooled data comprising 110 shoulder
dystocia cases, 11 impacted breech and 11 locked twin deliveries assessed from ten
case series and 38 individual case reports. Although recommended when other external
and internal manipulations have failed, we suspect that many clinicians have not had
formal training on how to conduct the manoeuvre and may be unfamiliar with the steps
involved, leading to a reluctance and delay in initiating this. We describe original
descriptions of the manoeuvre, examine its use in intractable shoulder dystocia and
illustrate stepwise the cephalic replacement technique. For this review, we have concentrated
mainly on the outcomes of the Zavanelli manoeuvre in shoulder dystocia but have also
touched on its role in impacted breech and locked twin deliveries. Lastly, we discuss
the cognitive load an obstetrician faces when having to make time critical decisions
in severe shoulder dystocia and share how other disciplines train and prepare their
personnel to manage similar rare and unexpected scenarios.
Keywords
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Article info
Publication history
Published online: September 17, 2021
Accepted:
September 12,
2021
Received in revised form:
September 10,
2021
Received:
May 22,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
