Assisted delivery of mobile fetal head: a comparison of forceps, vaccum and assisted manual extraction of head at caesarean section

Abstract

Background: Difficult fetal extraction occurs in 1-2% of caesarean deliveries. Either forceps or a vaccum device is often used to assist in delivery of the fetal head in cesarean section in high floating/mobile fetal head. This study compare the safety (for mother and fetus) and efficacy of forceps and vacuum assisted delivery of high floating/mobile fetal head with the traditional method of manual extraction at caesarean section.Methods: The sample size included 100 cases of LSCS with manual extraction of fetal head, 100 cases of LSCS with forceps assisted extraction of fetal head and 100 cases of LSCS with vacuum assisted extraction of fetal head.Results: Application of fundal pressure was required in all cases of manual extraction group, in 51 cases of forceps extraction group. None of the cases of vacuum extraction group required application of fundal pressure. The U-D interval in manual extraction group was 90.56±4.91 seconds, in forceps extraction group was 70.2±5.02 seconds and in the vacuum extraction group it was 62.3±2.03 seconds. In the manual extraction group, there was an estimated blood loss of 428±69.38 ml, 579±97.22 ml of estimated blood loss was present in forceps extraction group and in the vacuum extraction group it was 454±66.92 ml.Conclusions: This study reveals that with use of vacuum in CS for delivery of floating head, is superior than application of forceps and manual delivery in relation to time, blood loss and fundal pressure without any adverse effect on neonates and maternal complication.

Internal podalic version for delivery of high floating head during cesarean section and neonatal outcome

“…Swain et al 9 compared the use of forceps, vacuum and manual extraction in delivery of high floating head during cesarean section, their results agreed with ours as regards that the vacuum is better than forceps in delivery of high floating head, with even a similar numbers as regard the time required for delivery of the fetus (59.48, 54.52 s for forceps group, vacuum group, respectively, in our study as compared to 70.2, 62.3 s for forceps group, vacuum group, respectively, in their study), and less complications, but they did not include the internal podalic version technique in their study and interestingly the timing of delivery of fetal head in our study is still shorter (24.86 s in internal podalic version group).…”

“…Most of the guidelines recommend the use of short curved forceps (Wrigley) in delivery of high floating head during cesarean section . But the problem in use of this short curved forceps in delivery of high floating head is the use of instrument which may be traumatic to the uterus and to the baby and may affect the maternal and fetal tissues if misapplied …”

“…7,8 But the problem in use of this short curved forceps in delivery of high floating head is the use of instrument which may be traumatic to the uterus and to the baby and may affect the maternal and fetal tissues if misapplied. 9 The use of vacuum to extract the high floating head during cesarean section has been suggested in many studies with fewer traumatic complications than forceps, but with very prolonged delivery time, which will threaten the baby to the risk of respiratory distress. 10,11 So alternative to this method should be developed and in our study we use the technique of internal podalic version for delivery of fetal head as alternative to short curved forceps and vacuum.…”