Disengagement of the Deeply Engaged Fetal Head during Cesarean Section Conventional Method versus Reverse Breech Extraction- Review of Literature

Seema Chopra

doi:10.4172/2090-7214.1000239

Abstract

Obstructed labor with the fetal head impacted in pelvis is an obstetric complication that requires cesarean delivery with skilful handling. Extraction and delivery of the fetal head in this situation can be achieved utilizing either an ‘abdomino-vaginal’ approach or ‘reverse breech extraction’. Other techniques include use of a ‘Dis impaction system’ or ‘Patwardhan technique’. However, caesarean delivery cannot provide assurance against maternal and neonatal morbidity. Evidence is needed to guide clinicians as to which technique; reverse breech extraction or push method best facilitates delivery with the least complications for mother and baby. The superiority of one technique over another is yet to be proven. The present review indicates that the pull technique has relative advantages over the push method in cases of impacted fetal head at cesarean delivery with regard to fetal and maternal complications.

Highlights

The majority of pregnant women as well as obstetricians aim for normal vaginal birth
The present review indicates that the pull technique has relative advantages over the push method in cases of impacted fetal head at cesarean delivery with regard to fetal and maternal complications
Dystocia, which complicates up to 20% of all vaginal deliveries [1] is often diagnosed in the second stage of labor, when the fetal head is engaged in the pelvis, and vaginal delivery is replaced by cesarean

Summary

Introduction

The majority of pregnant women as well as obstetricians aim for normal vaginal birth. The contributing factors for increasing rate of second stage caesareans, first of all may be because of concurrent increase in cesarean births and a corresponding decrease in rates of instrumental deliveries as many fetuses with head deeply engaged in pelvis could have been managed in the past by either vacuum or forceps extraction are nowadays delivered by cesarean section [6]. Impaction of the fetal head is usually not associated with cephalopelvic disproportion, where the fetal head fails to descend in the maternal pelvis It is a manifestation of an unduly prolonged second stage, when the obstetrician has to decide upon mode of deliverywhether instrumental delivery or a cesarean section [20]. Different techniques are described in the literature [25, 29, 30] The superiority of one technique over another is yet to be proven [29,31,32] (Table 1)

Push Method Pull Method

Findings

Conclusion