The Zavanelli maneuver: a potentially revolutionary method for the resolution of shoulder dystocia.

Shoulder dystocia is a perilous complication for the fetus. Suffocation and death are imminent. For the obstetrician, there is insufficient time for consultation. Either he or she is ready with an array of manipulative remedies for sequential application or a disorganized chaos will ensue and chance will determine the outcome. Worthy accoucheurs will have planned for this event and will have selected from the numerous procedures touted for its correction that group he or she intuitively feels will be most effective or, at a minimum, most easily remembered. The Zavanelli maneuver deserves to be on every obstetrician's list. It must occupy a bottom priority, however, until its virtue and applicability, demonstrated to date in but a single case, can be confirmed. All current maneuvers for the treatment of shoulder dystocia are directed to completion of vaginal delivery. The Zavanelli maneuver is predicated on cephalic replacement with subsequent delivery by cesarean section.