Catastrophic shoulder dystocia and emergency symphysiotomy

We present three cases of shoulder dystocia unrelieved by standard maneuvers, including cephalic replacement. Symphysiotomy was performed in an effort to preserve fetal life. All three infants sustained severe neurologic injury and later died. Maternal morbidity including urinary incontinence was significant but responded to treatment. Symphysiotomy may be the only me[nod of relieving some cases of shoulder dystocia, but its role remains unclear because of operator inexperience and maternal morbidity.