Posterior axilla sling traction: a new technique for severe shoulder dystocia

Hoek, Joop van den; Verkouteren, Babette J A; Hamont, Dennis van

doi:10.1136/bcr-2018-226882

Cited by 5 publications

(1 citation statement)

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“…We modified the sling method by using two long ribbon gauzes tied together and a right-angle forceps for several advantages. While neonatal suction tubes or Foley catheters have to be folded to form a loop and then used as a sling, the knot of the ribbon gauze can be easily held between the fingers and brought to the fetal axilla [5,[7][8][9][10] (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

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

Kwan

Hui

Lee

et al. 2021

BMC Pregnancy Childbirth

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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.

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Section: Discussionmentioning

confidence: 99%