Hysterotomy to effect vaginal delivery with mentum anterior head entrapment.

Background: Entrapment of the aftercoming head after mentum anterior rotation is a life-threatening complication of vaginal breech delivery. Few options exist when rotation and flexion from this position cannot be performed successfully either transabdominally or with vaginal maneuvers.

Case: A term primigravida presented with a singleton breech in advanced labor. The fetal torso and arms delivered vaginally, but the aftercoming head became extended and was entrapped in a mentum anterior position. The fetal head could not be rotated and flexed, either vaginally or transabdominally with suprapubic pressure. Laparotomy and hysterotomy were performed, and vaginal delivery of a live fetus was accomplished after rotation and flexion of the fetal head through this incision.

Conclusion: Hysterotomy is a safe and effective maneuver for delivery of the entrapped fetal head with mentum anterior rotation after standard procedures have failed.