REVERSE BREECH EXTRACTION VS HEAD PUSHING FOR DELIVERY OF DEEPLY IMPACTED FETAL HEAD IN EMERGENCY CAESAREAN SECTION
AbstractBackground: Obstructed labour is considered a negligible component of maternal mortality in developed countries but it is a major mortality burden in developing countries. This study was done to compare maternal outcome associated with reverse breech extraction and vaginal head pushing method for the deeply impacted foetal head in emergency caesarean section. Methods: It was done at the Department of Obstetrics and Gynaecology Military Hospital, Rawalpindi from May to Nov 2014. A total of 110 patients meeting our inclusion criteria were randomly divided into two groups, i.e., Group A (delivered by reverse breech extraction) and Group B (delivered by hand push method). Patient demographic data and maternal outcomes were compared among both groups. Data was analysed using SPSS-21. Results: Mean age of the patients was 27.51±6.60 and 27.91±6.85 years in Group-A and B respectively with an age range of 15–45 years while the mean gestational age was 39.93±0.87 weeks and 40.05±0.62 weeks in Group A and B respectively. 27 (49.1%) from Group A and 26 (47.3%) from Group B were primigravida. Extension of uterine incision was observed in 5 (9.1%) patients of group-A and 25 (45.5%) patients of group-B. Mean operative duration was 42.47±3.00 min and 51.73±2.14 min in Group A and B respectively. More blood loss was observed in Group-B when compared with Group-A (1542.36±188.27 ml vs 1090.36±130.08 ml). A statistically significant difference was seen in both groups regarding maternal outcomes (p<0.001). Conclusion: Reverse breech extraction for delivery of deeply impacted foetal head during the emergency caesarean section is a safe and quick technique as compared to the push method.Keywords: Reverse breech extraction; vaginal head pushing; Caesarean section; obstructed labour
Wells JC. The New “Obstetrical Dilemma”: Stunting, Obesity and the Risk of Obstructed Labour. Anat Rec (Hoboken) 2017;300(4):716–31.
Usharani N, Bendigeri M. A study on clinical outcome of obstructed labour. Int J Reprod Contracept Obstet Gynecol 2017;6(2):439.
Ahmed Y, Solomon L, Girma A. “Prevalence and Management Outcome of Obstructed Labor among Mothers Who Gave Birth Between January, 2013 and December, 2015 in Metu Karl Referal Hospital, Ilu Ababora Zone, South West Ethiopia”. EC Gynaecology 2017:4(4):126–33.
Mekbib T, Kassaye E, Getachew A. FIGO Save the mothers Initiative. Ethiopia-Sweden Collaboration. Int J Gynaecol Obstet 2003;81(1):93–102.
Ukke GG, Gudayu TW, Gurara MK, Amanta NW, Shimbre MS. Feto-maternal outcomes in obstructed labor in Suhul General Hospital, North Ethiopia. Int J Nurs Midwifery 2017;9(6):77–84.
Kadhum TJ. Head pushing versus reverse breech extraction for delivery of impacted fetal head during Cesarean section. Kufa Med J 2009;12(1):200–5.
Nwogu-Ikojo EE, Nweze SO, Ezegwui HU. Obstructed labour in Enugu, Nigeria. J Obstet Gynaecol 2008;28(6):596–9.
Swaroop N, Sharma P, Kumari K, Seth S. Obstructed labour caused by rare congenital anomaly of foetus: managed by foetal abdominal tapping leading to successful vaginal delivery. Int J Reprod Contracept Obstet Gynecol 2017;4(4):1220–2.
Chopra S. Disengagement of the Deeply Engaged Fetal Head during Cesarean Section Conventional Method versus Reverse Breech Extraction- Review of Literature. Clin Mother Child Health 2016;13(2):1000239.
Randhawa A, Singh D, Kapoor D. Impact of Surgical Techniques in Maternal Morbidity and Foetal Outcome in Obstructed Labour: A Retrospective Study of 100 Cases of Obstructed Labour. J Dent Med Sci 2016;15(7):23–8.
Ziyauddin F, Hakim S, Khan T. Delivery of the deeply engaged fetal head during cesarean section in advance labor: a comparative study of head pushing versus reverse breech extraction. Curr Pediatr Res 2013;17(1):41–3.
Asıcıoglu O, Güngördük K, Yildirim G, Asıcıoglu B, Güngördük Ö, Ark C, et al. Second-stage vs first-stage caesarean delivery: Comparison of maternal and perinatal outcomes. J Obstet Gynaecol 2014;34(7):598–604.
Alexander J, Leveno K, Rouse D, Landon M, Gilbert S, Spong C, et al. Comparison of Maternal and Infant Outcomes From Primary Cesarean Delivery During the Second Compared With First Stage of Labor. Obstet Gynecol Surv 2007;62(8):497–8.
Veisi F, Zangeneh M, Malekkhosravi S, Rezavand N. Comparison of “push” and “pull” methods for impacted fetal head extraction during cesarean delivery. Int J Gynecol Obstet 2012;118(1):4–6.
Berhan Y, Berhan A. A meta-analysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery. Int J Gynecol Obstet 2013;124(2):99–105.
Frass KA, Al Eryani A, Al-Harazi AH. Reverse breech extraction versus head pushing in cesarean section for obstructed labor. A comparative study in Yemen. Saudi Med J 2011;32(12):1261–6.
Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay Z. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. Eur J Obstet Gynecol Reprod Biol 2005;121(1):24–6.
Bairwa R, Garg GS, Agrawal M, Chittora SP. Delivery of baby in obstructed labour by patwardhan technique-an observational study. Education (ASME) 2016;3(2):132.
Jeve Y, Navti O, Konje J. Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis. BJOG 2015;123(3):337–45.
Bastani P, Pourabolghase S, Abbasalizadeh F, Motvalli L. Erratum to “Comparison of neonatal and maternal outcomes associated with head-pushing and head-pulling methods for impacted fetal head extraction during cesarean delivery” [Int. J. Gynecol. Obstet. 118 (2012) 1-3]. Int J Gynecol Obstet 2012;119(3):292.
Fasubaa OB, Ezechi OC, Orji EO, Ogunniyi SO, Akindele ST, Loto OM, et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods. J Obstet Gynaecol 2002;22(4):375–8.
Saleh H, Kassem G, Mohamed M, Ibrahiem M, El Behery M. Pull Breech out versus Push Impacted Head up in Emergency Cesarean Section: A Comparative Study. Open J Obstet Gynecol 2014;4(6):260–5.
Chopra S, Bagga R, Keepanasseril A, Jain V, Kalra J, Suri V. Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: Conventional method versus reverse breech extraction. Acta Obstet Gynecol Scand 2009;88(10):1163–6.
Baloch S, Khaskheli M, Khushk IA, Sheeba A. Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section. J Ayub Med Coll Abbottabad 2008;20(1):87–90.
Leveno K, Nelson D, McIntire D. Second-stage labor: how long is too long? Am J Obstet Gynecol 2016;214(4):484–9.
Khan S, Roohi M. Obstructed Labour. The Preventable Factors. J Pak Med Assoc 1995;45:261–2.
Shaikh S, Shaikh A, Shaikh S, Isran B. Frequency of Obstructed Labor in Teenage Pregnancy. Nepal J Obstet Gynaecol 2013;7(1):37–40.
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