CATASTROPHIC SHOULDER DYSTOCIA AND EMERGENCY SYMPHYSIOTOMY

We present three cases of shoulder dystocia unrelieved by standard man euvers, 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. Symphysiotom y may be the only method of relieving some cases of shoulder dystocia, but its role remains unclear because of operator inexperience and mat ernal morbidity.