Ross Michael G, Beall Marie H
Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Obstet Gynecol. 2006 Sep;108(3 Pt 2):737-8. doi: 10.1097/01.AOG.0000218694.07694.36.
In the management of shoulder dystocia, fetal head replacement into the uterus has been advocated should delivery attempts remain unsuccessful. Reports of the Zavanelli maneuver have been remarkably optimistic despite the challenges of the procedure.
A gravida 3 para 2 (two previous vaginal deliveries of more than 4,500-g infants) with gestational diabetes presented at term. Following a low forceps delivery, shoulder dystocia was encountered and was unable to be relieved with standard maneuvers. A cesarean delivery was performed, shoulders disimpacted, and the infant delivered abdominally. A 4,680-g stillborn infant was delivered with radiologic and autopsy evidence of cervical C5-C6 dislocation.
Despite published reports of high success rates and limited fetal consequences, physicians should be aware of adverse consequences including cervical neck trauma associated with use of the Zavanelli maneuver.
在肩难产的处理中，若分娩尝试仍未成功，有人主张将胎儿头部回纳至子宫内。尽管该操作存在挑战，但有关扎瓦内利手法（Zavanelli maneuver）的报道一直相当乐观。
一名孕3产2（此前有两次阴道分娩，婴儿体重均超过4500克）且患有妊娠期糖尿病的孕妇足月就诊。在低位产钳分娩后，发生了肩难产，且标准手法无法缓解。遂行剖宫产，娩出受阻的肩部，婴儿经腹部娩出。一名体重4680克的死产婴儿出生，影像学和尸检证据显示存在颈椎C5 - C6脱位。
尽管已发表的报告称成功率高且对胎儿的影响有限，但医生应意识到包括与扎瓦内利手法相关的颈部创伤在内的不良后果。
