Abstract
Aims and Objectives: To compare the maternal and neonatal morbidities and to identify the etiology of obstructed labor and retrospective analyze the pull and push techniques for delivery of impacted head during cesarean section. Method: This observational study was conducted in IPGME and R, SSKM medical college from April 2015 to Feb 2019. The study population included 74 women tackled with the pull method, while the control group comprised 74, age and parity matched who underwent the push method of head delivery. Results: A review of 74 patients revealed the average age of the study population was 25.7±2 years. Patients with anemia (Hb≤8.5 to 10gm/dl) and abnormal BMI (>30and<24) were observed to suffer more from obstructed labor (p≤0.050). On the other hand, maternal height was not found to predict obstructed labor(p=0.5300). Patients with pull methods were noted to have less intra-operative fetal complication i.e. uterine artery injury (4 VS 19; P≤0.O5) transverse excision of the uterine incision (8vs 19; p≤0.05), vertical extension (1 vs 14; p ? 0.05)). Post-operative morbidity was also less, like fever( 01 vs31 ;p≤ 0.05), wound infection (2 vs 12; p≤ 0.05) and blood transfusion requirement (7 vs 16; p≤ 0.05), hospital stay more than seven days (4 vs 22; p≤ 0.05), There was no significant statistical difference between either group in terms of neonatal outcome. Conclusion: Although the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than push method in impacted fetal head extraction during cesarean delivery. Thus, this method of head delivery may enable a better fetomaternal outcome in obstructed labor.
Highlights
There is no clear definition and confusion of terms used by different authors remains [1]
The term "dystocia" is most frequently used as an equivalent for obstructed labor, but it covers a broad range of conditions, from labor lasting more than 12 hours to uterine rupture, fetal-pelvic disproportion or abnormal fetal presentation
Prolong obstruction in the second stage leads to a gradual impaction of the head in the pelvis and it is stressful for mother and fetus
Summary
There is no clear definition and confusion of terms used by different authors remains [1]. Prolong obstruction in the second stage leads to a gradual impaction of the head in the pelvis and it is stressful for mother and fetus. It is the arrest of vaginal delivery of the fetus due to mechanical obstruction (despite adequate uterine contractions), it is defined as "obstructed labor" [2]. It has been documented in global Burden of Obstructed labor (GBD in the year 2000) by WHO that the incidence of obstructed labor is 4% to 6% and it accounts for 9% 0f all maternal death globally [3]. At the same time associated fetomaternal morbidities are high
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