Authors' reply re: Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta‐analysis

Jeve, Yadava; Navti, Osric; Konje, Justin C.

doi:10.1111/1471-0528.14141

Cited by 3 publications

(7 citation statements)

References 3 publications

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“…The deeply impacted fetal head is an obstetrical emergency situation, which requires a secure delivery technique to prevent undesirable maternal and neonatal consequences [1, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding a difficult fetal delivery, head pushing is the most commonly practised technique. However, reverse breech extraction has gradually been given higher priority, not only in developing countries with longer periods of second stage labour, but also in higher resource settings [1, 5, 6, 18, 19]. Rising rates of intrapartum caesarean sections and the presented significant differences of an uncomplicated compared to a difficult delivery highlight the importance of a safe intrapartum care for mother and child [6, 10].…”

Section: Discussionmentioning

confidence: 99%

“…This increased risk results from a prolonged incision-delivery time, uterotomy-delivery time, total operation time and are caused by a higher rate of extensions of the uterine wound, T-incisions and additional instrumental support. On the other hand, difficult fetal extraction leads to severe neonatal consequences such as significantly higher rates of neonatal umbilical arterial pH < 7.15 and admissions to the neonatal care unit [1, 7, 9]. Therefore, it is important to incorporate alternative methods of fetal delivery into the daily obstetrical routine for a better outcome for mother and child.…”

Section: Discussionmentioning

confidence: 99%

“…Performing a caesarean section with extraction of a deeply impacted fetal head out of the maternal pelvis is technically challenging even for experienced obstetricians. The difficulty for the surgeon is to disengage the impacted head by hand due to a lack of space between the muscular and bony maternal pelvis and the deeply impacted fetal head [1]. This procedure is associated with elevated maternal risks including unintentional extensions of the uterine incision into the vascular broad ligament, prolonged operation times and postpartum haemorrhage [2–8].…”

Section: Introductionmentioning

confidence: 99%

“…This procedure is associated with elevated maternal risks including unintentional extensions of the uterine incision into the vascular broad ligament, prolonged operation times and postpartum haemorrhage [2–8]. Furthermore, serious neonatal complications, for instance skull injuries causing cerebral haemorrhage and newborn hypoxia that result in higher neonatal admission rates are described [1, 7, 9].…”

Section: Introductionmentioning

confidence: 99%

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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

Kimmich

Zimmermann

Kreft

2019

BMC Pregnancy Childbirth

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Background Caesarean section with extraction of a deeply impacted fetal head is technically challenging and is associated with serious maternal and neonatal complications. The purpose of the study was to identify risks and evaluate selected outcome parameters associated with difficult fetal head extraction during caesarean section in advanced labour comparing two different extraction techniques (head pushing vs. reverse breech). Methods This retrospective cohort study was conducted at the Division of Obstetrics in a tertiary care hospital in Zurich, Switzerland. 629 women at term with a singleton pregnancy in cephalic presentation during advanced intrapartum caesarean section from December 2012 until December 2016 were evaluated. Primary outcome was the incidence of uterine incision extensions. Secondary outcomes were other selected maternal and neonatal outcome parameters. Data analysis was performed using SPSS with Mann-Whitney U independent sampling test and two-tailed Fisher’s exact test ( p < 0.01). Results Difficult fetal head extractions are associated with significantly elevated maternal and neonatal risks. When performed by reverse breech technique, significant lower rates of extensions of the uterine incision, shorter operation times and less operative blood loss were identified compared to the head pushing method. No statistically significant differences for the neonatal outcomes were described so far. However, among the group of difficult fetal delivery with the head pushing method two neonates had perinatal skull fractures, with one of those resulting in neonatal death. Conclusions The head pushing method is associated with higher maternal morbidity than the reverse breech method for extraction of a deeply engaged fetus during intrapartum caesarean section in advanced stage of labour.

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“…The deeply impacted fetal head is an obstetrical emergency situation, which requires a secure delivery technique to prevent undesirable maternal and neonatal consequences [1, 13].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Kimmich

Zimmermann

Kreft

2019

BMC Pregnancy Childbirth

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Fetal extraction maneuvers during cesarean delivery in the second stage of labor

Krispin

Fischer

Kneller

et al. 2020

The Journal of Maternal-Fetal & Neonatal Medicine

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Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor

Gil

Chill

Kogan

et al. 2019

J of Obstet and Gynaecol

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Aim: To compare maternal and neonatal outcomes between the 'head first' and 'legs first' delivery methods during a second stage cesarean section. Methods: We conducted a retrospective study between January 2009 and May 2015 at a large public university tertiary referral center. Included were all women who underwent cesarean delivery with a fully dilated cervix and a fetal head at the level of the ischial spines or below. The study population was divided into two groups according to way of fetal delivery: The 'legs first' (reverse breech) method and the 'head first' method. Demographics and maternal and fetal outcomes were retrieved for both groups. Results: During the study period 447 women underwent a cesarean section while their cervix was fully dilated. Of them, 321 met the inclusion criteria: One hundred and twenty-one (38%) were delivered using the 'legs first' method and 200 (62%) were delivered using the 'head first' method. Indication for surgery and fetal head station was similar for both groups. While no difference in overall intraoperative uterine incision extension rate was observed, a higher rate of uterine incision extension was demonstrated in the 'head first' group in cases in which the second stage was longer than 180 min (33 vs 8 cases, P = 0.02). No differences in maternal postoperative complication rates and neonatal outcomes were observed. Conclusion: Fetal extraction via the 'legs first' method during prolonged second stage of labor may lower maternal morbidity. Method of delivery does not seem to have an effect on neonatal outcomes.

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Authors' reply re: Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta‐analysis

Cited by 3 publications

References 3 publications

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

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

Fetal extraction maneuvers during cesarean delivery in the second stage of labor

Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor

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