Resolution of infant shoulder dystocia with maternal spontaneous symphyseal separation: a case report.

Background: Shoulder dystocia is the unpredictable and unpreventable nightmare of the obstetrician. We report a case of spontaneous pubic symphyseal separation, the first reported case to result in the resolution of shoulder dystocia.

Case: A 39-year-old woman, gravida 4, para 3, was admitted with ruptured membranes in labor at term. The patient had had an uncomplicated antenatal course and uneventful labor until shoulder dystocia occurred. This was relieved after 7 minutes when the infant was rapidly delivered as the posterior arm was grasped and swept across the infant's chest. Immediately after the epidural had worn off, the patient complained of hip pain and was found to have a significant symphyseal separation on radiography.

Conclusion: This case of shoulder dystocia did not respond to the usual maneuvers but eventually resolved by spontaneous separation of the symphysis pubis.