Lower thoracic spinal cord injury - A severe complication of shoulder dystocia

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.