Circumferential shoulder laceration after posterior axilla sling traction: a case report of severe shoulder dystocia

Abstract

Background: Shoulder dystocia is an unpredictable and potentially catastrophic complication of vertex vaginal delivery. Posterior axilla sling traction (PAST) has recently been proposed as a method to resolve severe shoulder dystocia when commonly used techniques have failed.

Case presentation: A 33-year-old woman (gravida 5, para 0) at 35 weeks, 1 day gestation underwent induction of labor for poorly controlled type 2 diabetes mellitus. Delivery of the large-for-gestational-age infant (4,060 g) was complicated by intractable shoulder dystocia, relieved at 3 minutes with PAST, resulting in a deep, circumferential laceration of the fetal posterior shoulder and contralateral phrenic nerve palsy.

Conclusions: PAST provides a potentially lifesaving option during intractable shoulder dystocia. Simulation or education about the technique facilitates its use when standard maneuvers fail. It is important to disseminate information about potential complications associated with these novel maneuvers.

Keywords: Case report; Complication; PAST; PAST technique; Posterior axillary sling traction; Shoulder dystocia.

Fig. 1

Left, Circumferential laceration of the posterior arm (day of birth) attributable to posterior axilla sling traction with a urinary catheter for severe shoulder dystocia. Right, Progression of healing (28th day of life) after definitive wound closure 2 weeks prior

Fig. 2

Left, Left midshaft humerus fracture on day of birth. Extension of the elbow and flexion and pronation of the wrist are evident and characteristic of Erb palsy. Right, Radiograph shows an elevated right hemidiaphragm, attributable to contralateral (right-sided) phrenic nerve injury