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.

Fat embolism syndrome. Changing prognosis.

Patients with the fat embolism syndrome are reported to have a severe course, with mortality as high as 15 percent. Recent studies have attributed improved prognosis to one or another treatment modality. We reviewed the 54 patients with clinical evidence of the posttraumatic fat embolism syndrome documented at the Foothills Hospital from 1968 to 1977. The criteria for diagnosis were fever (54/54), hypoxemia (52/52), diffuse pulmonary infiltrates (49/54), changes in sensorium (41/54), and petechiae (39/54). Therapy included supplemental oxygen (54), assisted ventilation with positive end-expiratory pressure (5), and corticosteroids (7). There were no deaths. Patients who have the fat embolism syndrome without associated life-threatening disease have a relatively good prognosis with modern therapy, in contrast to reports in most of the published literature.