Posterior axilla sling traction and rotation: A case report of an alternative for intractable shoulder dystocia

Taddei, Edoardo; Marti, Carolin; Capoccia-Brugger, Romina; Brunisholz, Yves

doi:10.1080/01443615.2016.1264070

Cited by 8 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The internal manoeuvres currently used to resolve shoulder dystocia, therefore, have been implemented largely because of case reports, individual practitioner experience and expert opinion. 9,10 MacKenzie et al 11 report increasing rates of shoulder dystocia with a trend of 0.3% per year. The rates of shoulder dystocia in the study were seen to increase from 0.54% in 2006 to 1.26% in 2013.…”

Section: Discussionmentioning

confidence: 99%

Axillary traction: An effective method of resolving shoulder dystocia

Ansell

McAra‐Couper

et al. 2019

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

BackgroundAt Counties Manukau Health in Auckland, New Zealand, axillary traction is being used when an internal manoeuvre is required for resolution of shoulder dystocia.AimsThis study presents the outcomes for mother and baby from use of axillary traction and other internal manoeuvres.Materials and MethodsRetrospective review of the clinical records of mother and baby for all labours complicated by shoulder dystocia was carried out for an eight‐year period. Maternal and neonatal information were compared for the three cohorts of the first internal manoeuvre documented: axillary traction, posterior arm delivery and rotational manoeuvres.ResultsThere were 226 women who required the use of internal manoeuvres with no significant differences in age, body mass index, parity, ethnicity, diabetes incidence, induction and augmentation of labour rates, length of the first stage and birth weight between the cohorts. Axillary traction was the first internal manoeuvre used for 119 (52.7%) with a success rate of 95.8%. Posterior arm delivery was used first for 49 (21.7%) women with a success rate of 85.7%. Rotational manoeuvres were used first for 58 (25.7%) women with a statistically inferior success rate of 48.3%. There was no significant difference in the maternal and neonatal complication rates between the cohorts.ConclusionAxillary traction has been utilised as the first internal manoeuvre for a large number of women with a higher success rate than other internal manoeuvres without any increase in maternal or neonatal morbidity. It is recommended that this be the first internal manoeuvre attempted when shoulder dystocia occurs.

show abstract

Section: Discussionmentioning

confidence: 99%

Axillary traction: An effective method of resolving shoulder dystocia

Ansell

McAra‐Couper

et al. 2019

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…This ensures an even better grip on the sling. In the case report of Taddei et al , where the traction was not successful, the sling was eventually used to rotate the posterior shoulder 4. This option can be considered if traction alone fails to deliver the posterior shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the rapid success they started to practice the technique on several cases with severe shoulder dystocia before intrauterine death occurred 3. In response to this, a case in Switzerland had been described where applying traction to the sling alone was not successful 4. However, rotation of the posterior shoulder using the sling resulted in a quick delivery.…”

Section: Introductionmentioning

confidence: 99%