Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction: Shoulder dystocia is an obstetric emergency that occurs when the fetal anterior shoulder becomes impacted behind the maternal symphysis pubis after delivery of the head. This is a time-sensitive condition that can result in neonatal hypoxia, brachial plexus injury, and significant maternal morbidity. When standard obstetric maneuvers fail and cesarean delivery is not feasible or possible, symphysiotomy may be considered as a last resort intervention. This procedure involves surgical division of the pubic symphysis cartilage to widen the pelvic diameter and relieve the bony obstruction. This case describes a 28-year-old woman whose vaginal delivery was complicated by severe shoulder dystocia that ultimately required symphysiotomy for resolution.
Objective: The objective of this case study is to examine the effectiveness of symphysiotomy in facilitating delivery complicated by shoulder dystocia.
Methods: A 28-year-old woman at 41 weeks gestation presented in active labor to a county hospital. Labor progressed rapidly, with shoulder dystocia encountered following delivery of the fetal head. The patient was placed in the McRoberts position, and suprapubic pressure was applied without resolution. The Woods corkscrew maneuver was then attempted, followed by the Rubin maneuver and an attempt to deliver the posterior arm, but all maneuvers were unsuccessful. Because neither an operating room nor a cesarean crash cart was available, the decision was made to proceed with a symphysiotomy. A midline incision was made over the pubic symphysis to facilitate division of the symphyseal cartilage. The patient was instructed to push, resulting in separation of the pubic symphysis, which relieved the obstruction and allowed successful delivery of the infant. Post-delivery stabilization and repair were subsequently managed by the orthopedic surgery team.
Results: The delivery was successful, and the neonate had APGAR scores of 2, 4, and 9 at 1, 5, and 10 minutes, respectively. The orthopedic team was consulted for post-delivery management. Maternal postoperative recovery was supported by orthopedic suture repair, followed by pelvic stabilization with binding and initiation of physical therapy.
Conclusion: This case demonstrates that a symphysiotomy can be an effective rescue intervention when standard maneuvers for shoulder dystocia fail, particularly in settings where an operating room or cesarean capability is not immediately available. In emergent situations, symphysiotomy may facilitate delivery by increasing the pelvic diameter and relieving bony obstruction. These findings highlight the potential role of symphysiotomy in rural or resource-limited environments, where delays in operative delivery may significantly increase neonatal morbidity and mortality. Given the risks associated with the Zavanelli maneuver, including prolonged time to delivery and increased fetal hypoxia, symphysiotomy may, in selected severe cases, represent a timelier alternative. Re-examining the role of symphysiotomy in carefully chosen cases of refractory shoulder dystocia may be warranted, particularly when immediate cesarean delivery is not feasible and expeditious delivery is critical to neonatal outcome.
Embargo Period
6-2-2026
Included in
Emergency Symphysiotomy for Severe Shoulder Dystocia
Suwanee, GA
Introduction: Shoulder dystocia is an obstetric emergency that occurs when the fetal anterior shoulder becomes impacted behind the maternal symphysis pubis after delivery of the head. This is a time-sensitive condition that can result in neonatal hypoxia, brachial plexus injury, and significant maternal morbidity. When standard obstetric maneuvers fail and cesarean delivery is not feasible or possible, symphysiotomy may be considered as a last resort intervention. This procedure involves surgical division of the pubic symphysis cartilage to widen the pelvic diameter and relieve the bony obstruction. This case describes a 28-year-old woman whose vaginal delivery was complicated by severe shoulder dystocia that ultimately required symphysiotomy for resolution.
Objective: The objective of this case study is to examine the effectiveness of symphysiotomy in facilitating delivery complicated by shoulder dystocia.
Methods: A 28-year-old woman at 41 weeks gestation presented in active labor to a county hospital. Labor progressed rapidly, with shoulder dystocia encountered following delivery of the fetal head. The patient was placed in the McRoberts position, and suprapubic pressure was applied without resolution. The Woods corkscrew maneuver was then attempted, followed by the Rubin maneuver and an attempt to deliver the posterior arm, but all maneuvers were unsuccessful. Because neither an operating room nor a cesarean crash cart was available, the decision was made to proceed with a symphysiotomy. A midline incision was made over the pubic symphysis to facilitate division of the symphyseal cartilage. The patient was instructed to push, resulting in separation of the pubic symphysis, which relieved the obstruction and allowed successful delivery of the infant. Post-delivery stabilization and repair were subsequently managed by the orthopedic surgery team.
Results: The delivery was successful, and the neonate had APGAR scores of 2, 4, and 9 at 1, 5, and 10 minutes, respectively. The orthopedic team was consulted for post-delivery management. Maternal postoperative recovery was supported by orthopedic suture repair, followed by pelvic stabilization with binding and initiation of physical therapy.
Conclusion: This case demonstrates that a symphysiotomy can be an effective rescue intervention when standard maneuvers for shoulder dystocia fail, particularly in settings where an operating room or cesarean capability is not immediately available. In emergent situations, symphysiotomy may facilitate delivery by increasing the pelvic diameter and relieving bony obstruction. These findings highlight the potential role of symphysiotomy in rural or resource-limited environments, where delays in operative delivery may significantly increase neonatal morbidity and mortality. Given the risks associated with the Zavanelli maneuver, including prolonged time to delivery and increased fetal hypoxia, symphysiotomy may, in selected severe cases, represent a timelier alternative. Re-examining the role of symphysiotomy in carefully chosen cases of refractory shoulder dystocia may be warranted, particularly when immediate cesarean delivery is not feasible and expeditious delivery is critical to neonatal outcome.