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Meta-Analysis
. 2022 Feb 7;50(4):446-456.
doi: 10.1515/jpm-2021-0572. Print 2022 May 25.

Maternal and neonatal outcomes associated with delivery techniques for impacted fetal head at cesarean section: a systematic review and meta-analysis

Maria Patricia Rada  1 , Răzvan Ciortea  1 , Andrei Mihai Măluțan  1 , Ioana Prundeanu  1 , Stergios K Doumouchtsis  2   3   4   5   6 , Carmen Elena Bucuri  1   7 , Ligia Daniela Blaga  8 , Dan Mihu  1
Affiliations
Meta-Analysis

Maternal and neonatal outcomes associated with delivery techniques for impacted fetal head at cesarean section: a systematic review and meta-analysis

Maria Patricia Rada et al. J Perinat Med. .

Abstract

Objectives: Late first-stage or second-stage cesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-analysis was to compare maternal and neonatal outcomes associated with delivery techniques via cesarean section.

Methods: An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomised comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during cesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses.

Results: Nineteen articles, including 2,345 women were analyzed. Three fetal extraction techniques were identified. Meta-analyses showed that the "pull" technique carries lower risks as compared to the "push" technique and the "Patwardhan" technique is safer compared to the "push" or the "push and pull" technique.

Conclusions: In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the "pull", as well as the "Patwardhan" technique represent safe options to deliver an impacted fetal head.

Keywords: Patwardhan method; cesarean section; impacted head; pull method; push method.

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