Abstract
Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%; p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.
Highlights
Emergency Caesarean section is performed as an obstetric emergency, where intrapartum complications suddenly raised, and swift action is required to prevent the demises of mother, fetus or both [1]-[3]
Obstructed labor occurs when there is no progress in labor in spite of strong uterine contraction as shown by failure of cervix to dilate or failure of presenting part to descend through birth canal [4]
The percentage of second stage Cesarean Section is on the rise as there is a higher incidence of failure of instrumental delivery, and patients’ reluctance to instrumental delivery especially forceps as cesarean section is a safer option and strict guidelines for the length of labor [6]
Summary
Emergency Caesarean section is performed as an obstetric emergency, where intrapartum complications suddenly raised, and swift action is required to prevent the demises of mother, fetus or both [1]-[3]. Emergency cesarean section and delivery of the fetus are difficult in advanced second stage of labor as fetal head is deeply impacted in the pelvis and carriage, a higher risk of complications for both the mother and the baby. A reverse breech extraction technique (pull method) is usually performed by opening the uterus soon to reach into the upper segment for a fetal leg, and by applying gentle traction on the leg until the another leg appeared. Both legs are held together and the body of fetus could be delivered (pulled) out of the uterus completely using technique similar to that for a breech delivery [9]. The purpose of this study is to compare the complications (maternal and fetal) of reverse breech extraction (Pull) technique versus Head push technique (push) in delivering the deeply wedged fetal head during emergency caesarean section with active advanced labor
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