Other Known Aliases – cephalic replacement, Gunn-Zavenelli-O’Leary Manuever
Definition – replacement of the fetal head back into the uterus followed by immediate cesarean delivery
Clinical Significance – this is a controversial, last resort maneuver to a shoulder dystocia and involves rotating the head back to an occiput anterior position, flexing the head , and pushing it as far cephalad as possible. The other hand can be used depress the perineum to relieve pressure on the umbilical cord. Although rarely used, single case reports do show a high rate of success.
History – Named after William Zavanelli (1926- ), an American obstetrician from California who received his medical doctorate from College of Osteopathic Physicians and Surgeons in Los Angeles in 1957. He would go on to have a modest career until 1978 when he performed his eponymous maneuver followed by a successful cesarean delivery. His partner wanted to publish the results immediately, but Zavanelli wanted to wait to see if there were any developmental issues with the child. After seven years, the case report was published. Of note, this manuever was performed 2 years prior by Gunn and his case report was published later in 1985 refuting the eponymous naming.
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- Sandberg EC. The Zavanelli maneuver: a potentially revolutionary method for the resolution of shoulder dystocia. Am J Obstet Gynecol. 1985;152(4):479-84 [link]
- O’Leary J, Gunn D. Cephalic replacement for shoulder dystocia. Am J Obstet Gynecol. 1985; 153(5):592-3. [pubmed]