Abdominovaginal delivery: Modification of the cesarean section operation to facilitate delivery of the impacted head

Untitled

“…The fact that an equal birth term sister with higher weight was born by spontaneous vaginal delivery with no incidents corroborates further our hypothesis. We believe that if confronted to an impacted fetal head after a prolonged second stage of labor with ruptured membranes, a cesarian section should be performed with abdomino-vaginal delivery [8]. The fetus' head should be lifted using the gynecologist's cupped hand into a transverse uterine incision to allow for extraction without the risk of traumatism by forceps or other maneuvers.…”

Disengagement of the Deeply Engaged Fetal Head during Cesarean Section Conventional Method versus Reverse Breech Extraction- Review of Literature

“…The oldest procedure of abdomino-vaginal delivery in the presence of an impacted fetal head was described during the early 1980s as a modified cesarean section [26], the wedged fetal head was pushed by an assistant's hand introduced through the vagina. On the other hand Lippert [33,34] suggested that the surgeon avoids further deflexion of head with one hand in the uterus and the other hand in the vagina pushes the head up.…”

“…Another modification of the push technique was described by Landesman et al [26]. He carried out the abdomino-vaginal delivery in modified lithotomy position, the legs abducted in either the 'Whitmore' or the 'frog' position, and with a cupped hand in the vagina, the wedged vertex gently lifted through the uterine incision.…”

“…The operation time was longer with the push method than with the pull method (overall standard mean differences (SMD)] 2.7; 95% CI, 0.57-4.82) [2,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. The duration of the hospital stay was also significantly longer in the push group [2]; however, the overall SMD showed no association with either technique [2,29,41].…”

“…Extraction and delivery of the fetal head in this situation can be achieved utilizing either an abdomino-vaginal approach with head pushing from the vagina [26] or reverse breech extraction, where the baby is delivered by grasping the feet or buttocks and delivering them through the incision, with the head delivered last [27]. Other techniques described include use of a Dis impaction system [28] or Patwardhan technique, where the infants' shoulders are delivered first, then the trunk, breech, limbs then finally the head [23].…”