[External over-rotation of the head in the treatment of high longitudinal shoulder position].

The shoulder dystocias are an anomaly of shoulder presentation which render difficult or prevent complete extraction of the trunk following birth of the head. Acute hypoxia ensues, threatening the infant's life. Additionally, termination of delivery, which must be effected without delay and is surgically difficult, is frequently associated with often permanent damage to the upper limbs. Macrosomatia of the child and a vaginal-surgical delivery initiated before the preceding part has reached the pelvic floor increase the probability of high longitudinal shoulder position occurring. Early and forced application of Kristeller's method also encourages manifestation of the condition and simultaneous wedging of the shoulders in the pelvic inlet. Taking into account the inadequate shoulder rotation above the pelvic inlet, "external over-rotation of the head" is recommended as a treatment for high longitudinal shoulder position. The technique is described in detail. As soon as the condition appears likely to occur, the head is grasped in the hands (applied flat) and turned, in first position with the back of the head toward the right, in second position with the back of the head toward the left. This must be done early, i.e., if possible before the shoulders are finally locked in the pelvic inlet. Further expression of the trunk must not be assisted by Kristeller's method until high transverse position of the shoulders has been achieved. Clinicosurgical experience gathered so far and the early morbidity of the 24 children in whom high longitudinal shoulder position was overcome in this way justify the recommendation of "external over-rotation of the head" as an effective primary treatment method.