Under what conditions are the abdominal rescue and Zavanelli maneuver utilized?

The abdominal rescue and Zavanelli maneuver are advanced techniques employed in cases of shoulder dystocia when previous attempts to resolve the issue have not been successful. These maneuvers are invasive and carry risks, so they are generally considered only after other, less invasive methods have failed to alleviate the situation.

The abdominal rescue maneuver involves pushing the fetal shoulders back into the birth canal to allow for further attempts to resolve the dystocia, while the Zavanelli maneuver involves pushing the fetal head back into the vagina to potentially perform a cesarean delivery. Both techniques are last-resort options, indicating that they are reserved for instances where all other strategies—such as the McRoberts maneuver or suprapubic pressure—have not worked to free the impacted shoulder.

Utilizing these maneuvers only after exhausting other methods ensures that their risks are outweighed by the necessity of resolving the delivery complication at hand.