Comparison of Feto-Maternal Outcomes of Conventional Method vs Reverse Breach Extraction Method in Delivering Deeply Engaged Foetal Head at Caesarean Section

Rabia  Fatima; Amna  Rafique; Anum  Mehr; Iram  Iqbal

doi:10.54112/bcsrj.v6i6.1183

Authors

Rabia Fatima Department of Gynaecology, DHQ Shahbaz Shareef Hospital, Multan, Pakistan
Amna Rafique Department of Gynecology, THQ Alipur, Pakistan
Anum Mehr Department of Gynecology, THQ Alipur, Pakistan
Iram Iqbal Department of Gynaecology, Ibne Sena Hospital, Multan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1183

Keywords:

Blood loss, Cesarean section, Incision extension, NICU admission, Obstructed labour, Push method, Reverse breech extraction

Abstract

Cesarean section in the presence of a deeply impacted fetal head during the second stage of labour presents a significant obstetric challenge. It is associated with increased maternal and neonatal complications. Optimal surgical technique is crucial in minimizing adverse outcomes, yet the ideal extraction method remains a topic of debate. Objective: To compare the maternal and neonatal outcomes of the conventional (push) method versus the reverse breech extraction method during emergency cesarean sections performed for obstructed labour. Methods: This randomised controlled trial was conducted in the Department of Obstetrics and Gynaecology Unit II, Lahore General Hospital, Lahore, from August 2019 to March 2020. A total of 110 women undergoing emergency cesarean section for obstructed labour were enrolled and randomly assigned to either Group A (conventional method) or Group B (reverse breech extraction method) using the lottery method. Key outcomes assessed included maternal blood loss, extension of uterine incision, and neonatal intensive care unit (NICU) admission. Data were analysed using appropriate statistical tests, and a p-value of <0.05 was considered significant. Results: The mean age of participants in Group A was 27.22 ± 5.08 years, and in Group B was 28.36 ± 4.52 years. The reverse breech group demonstrated significantly lower mean blood loss (842.64 ± 123.14 mL) compared to the conventional group (p < 0.001). Extension of uterine incision occurred in 32.7% of cases in Group B versus a higher proportion in Group A (p = 0.004). NICU admission was also significantly less frequent in Group B (5.5%) compared to Group A (p < 0.05). Conclusion: The reverse breech extraction method during emergency cesarean section for obstructed labour is associated with reduced intraoperative blood loss, lower incidence of uterine incision extension, and fewer NICU admissions. This technique offers a safer alternative to the conventional method and should be considered in managing deeply impacted fetal heads during obstructed labour.

Downloads

Download data is not yet available.

References

Neilson J, Lavender T, Quenby S, Wray S. Obstructed labour: reducing maternal death and disability during pregnancy. Br Med Bull. 2003;67(1):191–204. https://doi.org/10.1093/bmb/ldg018

Dolea C, AbouZahr C. Global burden of obstructed labour in the year 2000. Geneva: World Health Organization; 2003. p. 1–17.

Frass KA, Al Eryani A, Al-Harazi AH. Reverse breech extraction versus head pushing in cesarean section for obstructed labour—a comparative study in Yemen. Saudi Med J. 2011;32(12):1261–1266.

Kadhum T. Head pushing versus reverse breech extraction for delivery of an impacted fetal head during cesarean section. Kufa Med J. 2009;12(1):200–205.

Singh M, Varma R. Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument. Obstet Gynaecol. 2008;10(1):38–41. https://doi.org/10.1576/toag.10.1.038.27376

Kongnyuy EJ, Mlava G, van den Broek N. Establishing standards for obstructed labour in a low-income country. Rural Remote Health. 2008;8:1022. https://doi.org/10.22605/RRH1022

Melah GS, El-Nafaty AU, Massa AA, Audu BM. Obstructed labour: a public health problem in Gombe, Gombe State, Nigeria. J Obstet Gynaecol. 2003;23(4):369–373. https://doi.org/10.1080/01443610310001119510

Karasahin KE, Ercan M, Alanbay I, Baser I. Comment on 'Disengagement of the deeply engaged fetal head during cesarean section in advanced labour: conventional method versus reverse breech extraction'. Acta Obstet Gynecol Scand. 2010;89(6):849–850; author reply 851. https://doi.org/10.3109/00016340903410915

Allen VM, O'Connell CM, Baskett TF. Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. BJOG. 2005;112(7):986–990. https://doi.org/10.1111/j.1471-0528.2005.00615.x

Barbieri RL. Difficult fetal extraction at cesarean delivery: what should you do? OBG Manag. 2012;24(1):8.

Bahl R, Strachan B, Murphy D. RCOG Green-top Guideline No. 26: Operative Vaginal Delivery. London: Royal College of Obstetricians and Gynaecologists; 2011.

Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2011. Natl Vital Stat Rep. 2012;61(5):1–20. Hyattsville (MD): National Center for Health Statistics.

Kafali H. Cesarean breech extraction for impacted fetal head in deep pelvis after a prolonged obstructed labour: a cesarean technique variation. Internet J Gynecol Obstet. 2003;2(2).

Häger RM, Daltveit AK, Hofoss D, Nilsen ST, Kolaas T, Øian P, et al. Complications of Cesarean Deliveries: Rates and Risk Factors. Am J Obstet Gynecol. 2004;190(2):428–434. https://doi.org/10.1016/j.ajog.2003.08.037

Blickstein I. Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia. J Perinat Med. 2004;32(6):465–469. https://doi.org/10.1515/JPM.2004.152

Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay ZJ. Head pushing versus reverse breech extraction in cases of an impacted fetal head during cesarean section. Eur J Obstet Gynecol Reprod Biol. 2005;121(1):24–26. https://doi.org/10.1016/j.ejogrb.2004.09.014

Saleh HS, Kassem GA, Mohamed MES, Ibrahiem MA, El Behery MM. "Pull" breech out versus "push" impacted head up in emergency cesarean section: a comparative study. Open J Obstet Gynecol. 2014;4(6):260–265. https://doi.org/10.4236/ojog.2014.46042

Lenz F, Kimmich N, Zimmermann R, Kreft M. Maternal and neonatal outcome of reverse breech extraction of an impacted fetal head during caesarean section in advanced stage of labour: a retrospective cohort study. BMC Pregnancy Childbirth. 2019;19(1):98. https://doi.org/10.1186/s12884-019-2253-3

Ziyauddin F, Hakim S, Khan T. Delivery of the deeply engaged fetal head during cesarean section in advanced labour: a comparative study of head pushing versus reverse breech extraction. Curr Pediatr Res. 2013;17(1):41–43.

Bastani P, Pourabolghase S, Abbasalizadeh F, Motvalli L. Comparison of neonatal and maternal outcomes associated with head-pushing and head-pulling methods for impacted fetal head extraction during cesarean delivery. Int J Gynaecol Obstet. 2012;118(1):1–3. https://doi.org/10.1016/j.ijgo.2012.03.005

Veisi F, Zangeneh M, Malekkhosravi S, Rezavand N. Comparison of "push" and "pull" methods for impacted fetal head extraction during cesarean delivery. Int J Gynaecol Obstet. 2012;118(1):4–6. https://doi.org/10.1016/j.ijgo.2011.12.027

Chopra S, Bagga R, Keepanasseril A, Jain V, Kalra J, Suri V. Disengagement of the deeply engaged fetal head during cesarean section in advanced labour: conventional method versus reverse breech extraction. Acta Obstet Gynecol Scand. 2009;88(10):1163–1166. https://doi.org/10.1080/00016340903214932