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Zavanelli Maneuver Injuries

The Zavanelli Maneuver Used During Labor and Delivery

When shoulder dystocia occurs during a delivery, it is an emergency situation for the medical professionals attending the birth, and a terrifying experience for parents. The Zavanelli maneuver is a technique that may be used as a last resort for shoulder dystocia.

What Is Shoulder Dystocia?

Shoulder dystocia is a condition in which the baby’s head is delivered, but the shoulders remain stuck in the birth canal. One of the infant’s shoulders is impacted against the mother’s pelvic bone, preventing the child from being delivered. This is an emergency situation, as the longer it continues, the greater the chances of serious injury to both the mother and the baby.

Medical professionals must be prepared in advance to deal with shoulder dystocia. They must act immediately and effectively in an effort to free the impacted shoulder, deliver the child, and provide any emergency medical treatment that may be necessary after.

What Is the Zavanelli Maneuver?

The Zavanelli maneuver is generally performed only after other attempts to free the child have failed. In this maneuver, the baby’s head is first rotated into position and then flexed. The doctor applies constant, firm pressure, pushing the head back into the birth canal. Uterine-relaxing general anesthesia or tocolytic (anti-contraction) medications may be administered to facilitate the process. Emergency Cesarean section surgery must be performed immediately after the infant’s head has been successfully returned.

Zavanelli Maneuver and Birth Injuries

The Zavanelli maneuver is used as a "last ditch" effort for a reason. A study of 59 cases of shoulder dystocia in which the Zavanelli maneuver was performed revealed delays of five minutes to more than 30 minutes from the time the head was delivered until it was placed back into the birth canal. In six of these cases, the head could not be replaced at all, and in five cases, replacement was difficult.

Apgar scores, which measure the condition of a newborn on a scale of 0 to 10, were less than 6 at five minutes in 61% of the infants involved in the study, and less than 3 in 27%. Of the 59 Zavanelli maneuver births studied, four babies had seizures in the nursery, five suffered Erb’s palsy, two had permanent neurological damage, and two infants died.

Emergency Medical Response to Shoulder Dystocia

As discussed in an American Family Physician article, obstetrical healthcare providers should have a predetermined plan in place for emergency response to shoulder dystocia. The recommended plan involves:

  • Activating a pre-arranged protocol to get necessary personnel and equipment to the labor and delivery unit;
  • Evaluating the mother for emergency episiotomy to create sufficient room for rotation maneuvers if required;
  • Performing the McRoberts maneuver, in which the mother’s legs are flexed against the abdomen to tilt the pelvis;
  • Suprapubic pressure, applied with a fisted hand, just above the mother’s pubic bone to move the infant’s impacted shoulder;
  • Internal rotation maneuvers to release the infant’s shoulder;
  • Removing the child’s posterior arm from the birth canal (which must be done properly to avoid fracturing the humerus); and
  • Rolling the mother to an all-fours position to help dislodge the shoulder.

Speak with a Birth Injury Attorney Today

If your child has been injured at birth through medical negligence, birth injury lawyer Laura Brown is available at (214) 974-4121 to discuss your situation, answer questions about your baby's injuries and medical malpractice, and advise you of your legal rights. Please call today for a free, no-obligation consultation.


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