Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section

Abstract

Objective: To compare maternal and neonatal morbidity associated with two methods to extract the impacted fetal head during Cesarean delivery.

Study design: We retrospectively analyzed cases with difficult extraction of the impacted fetal head during Cesarean section. We compared maternal and neonatal outcomes between cases that were delivered by head extraction following pushing through the vagina ('push' method) and those that were delivered by the reverse breech technique ('pull' method).

Results: We reviewed 3105 Cesarean section reports. Difficult extraction necessitating the 'push' or 'pull' methods was noted in 48 (1.5%) instances. Women that were delivered by the 'pull' method had significantly lower rate of postpartum fever (5% versus 46%; odds ratios, 0.06; 95% confidence intervals, 0.007-0.51) and extensions of the uterine incision (15% versus 50%; odds ratio, 0.17; 95% CI, 0.04-0.74) compared to those that were delivered by the 'push' method. Neonatal outcomes were good in all cases.

Conclusions: In cases with difficult extraction of the impacted fetal head during Cesarean section, 'pull' method may result in lower maternal morbidity compared to the traditional 'push' method.