The uterus continues to try to expel the impacted fetus and as its retraction ring rises, the musculature in the lower segments thins out leading eventually to a uterine rupture and the death of the mother. Impacted shoulder presentations contribute to maternal mortality. Obviously a cesarean section should be performed before the baby has died, but even when the baby has died or impaction has occurred, C/S is the method of choice of delivery, as alternative methods of delivery are potentially too traumatic for the mother. If the baby is preterm or macerated and very small a spontaneous delivery has been observed. History
Prior to the arrival of C/S the fetus usually died during protracted labor and the mothers life was at risk as well due to infection, uterine rupture and bleeding. On occasion, if the baby was macerated and small, it collapsed sufficiently to be delivered. The shoulder presentation was a feared obstetrical complication. In 1690 Justine Siegemundin, a German midwife, published Die Kgl. Preußische und Chur-Brandenburgische Hof-Wehemutter. This treatise for midwives demonstrated abnormal presentations at birth and their management. She was the first to describe a two-handed method of performing an internal rotation of the baby to extract it as a breech (a variation of which is performed today on the second twin, see above) using a sling. The procedure was useful provided the fetus was not impacted. Once the uterus had contracted around the baby tightly, destructive interventions were used to save the life of the mother.
Fesoterodine (INN, used as the fumarate under the brand name Toviaz) is an antimuscarinic drug developed by Schwarz Pharma AG to treat overactive bladder syndrome (OAB). It was approved by the European Medicines Agency in April 2007, the US Food and Drug Administration on October 31, 2008  and Health Canada on February 9, 2012.Fesoterodine is a prodrug. It is broken down into its active metabolite, desfesoterodine, by plasma esterases. Efficacy
Fesoterodine has the advantage of allowing more flexible dosage than other muscarinic antagonists. Its tolerability and side effects are similar to other muscarinic antagonists and as a new drug seems unlikely to make great changes in practices of treatment for overactive bladder.A Japanese study from 2017, showed that urgency and urge incontinence are improved after 3 days administration of the drug, with full efficacy able to be judged after 7 days administration. Overactive bladder was found to be resolved in 88% of patients after seven days usage. References
External links
"Fesoterodine". Drug Information Portal. U.S. National Library of Medicine.