TITLE:
Pull Breech out versus Push Impacted Head up in Emergency Cesarean Section: A Comparative Study
AUTHORS:
Hend S. Saleh, Gamal A. Kassem, Mohamed El Said Mohamed, Moustafa A. Ibrahiem, Manal M. El Behery
KEYWORDS:
Deeply Engaged Head; Obstructed Labor; Cesarean Section; Reverse Breech Extraction; Head Push Method
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.6,
April
2,
2014
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.