Reverse breech extraction versus head pushing in cesarean section for obstructed labor. A comparative study in Yemen.
ABSTRACT To compare the maternal and fetal outcome of 2 different methods of delivering the baby during cesarian section when the fetal head is deeply engaged.
A prospective case control study was carried out in the Obstetrics and Gynecology Department, Al-Thawra General Hospital, Sana'a, Yemen from January to December 2010. A total of 118 women who met our criteria were included in the study. They were divided randomly into 2 groups. A study group (n=59) was assigned to deliver the baby by reverse breech extraction, and control group (n=59) was assigned to deliver by the conventional method. The maternal and neonatal outcomes between the 2 groups were compared.
Extension of the uterine incision occurred in significantly less women using reverse breech extraction compared to cephalic delivery (5% versus 40.6%; p=0.0001). It was observed that the mean operation time and blood loss in the study group were lower than that in the control group (52.9 +/- 5.1, 787 +/- 519 versus 67.2 +/- 4.7, 1231 +/- 471; p<0.0001). No significant difference between groups was noted in the maternal and neonatal outcomes.
Reverse breech extractions is an attractive and safe alternative to the standard method for intraoperative disengagement of a deeply impacted fetal head in order to reduce maternal and fetal morbidly.
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ABSTRACT: During cesarean delivery, extracting a deeply impacted head is a real challenge for obstetricians. To compare selected maternal and fetal outcome indicators of the "pull" (reverse breech extraction) and "push" methods for impacted fetal head extraction during cesarean delivery. A computer-based search of the Medline, Cochrane library, and HINARI databases. Studies that compared the maternal and perinatal outcomes of the push and pull methods for impacted fetal head extraction during cesarean delivery were included. A meta-analysis of Mantel-Haenszel odds ratios and standardized mean differences from 11 randomized comparative and retrospective cohort studies was performed. In the pooled analysis, the risk of uterine incision extension was more than 8 times higher with the push method than with the pull method. Blood loss and operation time were also increased with the push method, and this method was associated with more perinatal deaths and admissions to the neonatal intensive care unit. The risk of wound infection was not significantly different between the 2 methods. The present meta-analysis demonstrated marked reductions in uterine incision extension, blood loss, and operation time with reverse breech extraction.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 11/2013; · 1.41 Impact Factor
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ABSTRACT: The rates of cesarean section at full cervical dilatation (second stage cesarean sections) are currently increasing. The purpose of the present study is to compare maternal and neonatal morbidity and mortality among cases offered cesarean section at full dilatation to those offered cesarean section prior to full dilatation. We searched Medline, Scopus, Clinicaltrials.org, Popline, Cochrane CENTRAL, and Google Scholar search engines, along with reference lists from all included studies. The RevMan 5.0 software was used for all analyses. Primary maternal outcomes were defined as death, ICU admission and need for transfusion, while primary neonatal outcomes were defined as death, neonatal unit admission and 5min Apgar score less than 7. Ten studies were finally retrieved involving 23,104 singleton childbearing women (18,160 operated in the first stage and 4944 in the second stage of labor). Second stage cesarean section seems to lead to higher maternal admissions to ICU (OR 7.41, 95% CI 2.47-22.5) and higher transfusion rates (OR 2.60, 95% CI 1.49-2.54). Neonatal death rates were also increased (OR 5.20, 95% CI 2.49-10.85) along with admissions to neonatal unit (OR 1.63, 95% CI 0.91-2.91) and rates of Apgar score less than 7 in 5min (OR 2.77, 95% CI 1.02-7.50). Second stage cesarean section seems to result significantly increased morbidity for both mothers and neonates. It seems that a direct evaluation with forceps and vacuum extractors is imperative in order to establish its place in modern evidence-based practice.European journal of obstetrics, gynecology, and reproductive biology 01/2014; · 1.97 Impact Factor