ABSTRACT
Fundal pressure as a maneuver for the relief of shoulder dystocia is associated with
up to a 77% fetal injury rate. The usual injuries involve the brachial plexus or orthopedic
injuries. We now report a severe lower thoracic spinal cord injury with permanent
neurological injury when fundal pressure was applied in an attempt to relieve shoulder
dystocia. Shoulder dystocia occurred in a 28-year-old nulliparous woman. A series
of manual maneuvers to include episiotomy extension, McRoberts, suprapubic pressure,
Woods screw, and extraction of the posterior arm all failed to achieve delivery. During
these maneuvers, but not coordinated with them, fundal pressure was applied by multiple
individuals. The Zavanelli maneuver and cesarean delivery ultimately allowed delivery.
On Day 2 of life marked decrease in lower extremity motor function, over-flow urinary
incontinence, and rectal incontinence led to imaging studies that revealed focal spinal
cord injury at T-9 through T-12. Compressive forces applied to the fetal spine during
fundal pressure is the likely cause of the lower thoracic spinal cord injury manifest
by this newborn.
Keywords
Fundal pressure - thoracic cord injury
