Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report

Abstract Background Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was p...

Full description

Bibliographic Details
Main Authors: Angel Hoi Wan Kwan, Annie Shuk Yi Hui, Jacqueline Ho Sze Lee, Tak Yeung Leung
Format: Article
Language:English
Published: BMC 2021-10-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:https://doi.org/10.1186/s12884-021-04126-4
id doaj-fa86743e86944c96bad94930fa8ce3fe
record_format Article
spelling doaj-fa86743e86944c96bad94930fa8ce3fe2021-10-10T11:41:32ZengBMCBMC Pregnancy and Childbirth1471-23932021-10-012111410.1186/s12884-021-04126-4Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case reportAngel Hoi Wan Kwan0Annie Shuk Yi Hui1Jacqueline Ho Sze Lee2Tak Yeung Leung3Department of Obstetrics and Gynaecology, The Chinese University of Hong KongDepartment of Obstetrics and Gynaecology, The Chinese University of Hong KongDepartment of Obstetrics and Gynaecology, The Chinese University of Hong KongDepartment of Obstetrics and Gynaecology, The Chinese University of Hong KongAbstract Background Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. Case presentation A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. Conclusions We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension.https://doi.org/10.1186/s12884-021-04126-4Shoulder dystociaPosterior axillary slingHELPERR MnemonicPosterior arm extractionCase report
collection DOAJ
language English
format Article
sources DOAJ
author Angel Hoi Wan Kwan
Annie Shuk Yi Hui
Jacqueline Ho Sze Lee
Tak Yeung Leung
spellingShingle Angel Hoi Wan Kwan
Annie Shuk Yi Hui
Jacqueline Ho Sze Lee
Tak Yeung Leung
Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
BMC Pregnancy and Childbirth
Shoulder dystocia
Posterior axillary sling
HELPERR Mnemonic
Posterior arm extraction
Case report
author_facet Angel Hoi Wan Kwan
Annie Shuk Yi Hui
Jacqueline Ho Sze Lee
Tak Yeung Leung
author_sort Angel Hoi Wan Kwan
title Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_short Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_full Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_fullStr Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_full_unstemmed Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
title_sort intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report
publisher BMC
series BMC Pregnancy and Childbirth
issn 1471-2393
publishDate 2021-10-01
description Abstract Background Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. Case presentation A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. Conclusions We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension.
topic Shoulder dystocia
Posterior axillary sling
HELPERR Mnemonic
Posterior arm extraction
Case report
url https://doi.org/10.1186/s12884-021-04126-4
work_keys_str_mv AT angelhoiwankwan intrauterinefetaldeathfollowedbyshoulderdystociaandbirthbymodifiedposterioraxillaryslingmethodacasereport
AT annieshukyihui intrauterinefetaldeathfollowedbyshoulderdystociaandbirthbymodifiedposterioraxillaryslingmethodacasereport
AT jacquelinehoszelee intrauterinefetaldeathfollowedbyshoulderdystociaandbirthbymodifiedposterioraxillaryslingmethodacasereport
AT takyeungleung intrauterinefetaldeathfollowedbyshoulderdystociaandbirthbymodifiedposterioraxillaryslingmethodacasereport
_version_ 1716829638327533568