Cephalic Replacement for Shoulder Dystocia: Present Status and Future Role of the Zavanelli Maneuver

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To describe the pertinent clinical data, outcomes, and maternal and fetal complications of cephalic replacement for the management of shoulder dystocia.


A registry for the reporting of cases of cephalic replacement was established 5 years ago. Features of the registry cases were reviewed.


Fifty-nine women underwent replacement of the fetal head following unsuccessful attempts at vaginal delivery. All but six infants were successfully replaced and delivered by cesarean without excessive maternal or fetal morbidity.


Cephalic replacement is a useful technique that need not be used as a last resort, but may be considered if any undue difficulty is encountered. It may have a place as an initial technique for those inexperienced with shoulder dystocia treatment.

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