Comparison of “push” and “pull” methods for impacted fetal head extraction during cesarean delivery

Abstract

Although the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than the push method when used for impacted fetal head extraction during cesarean delivery.

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

“…The risk of lateral or downward extension of the uterine incision was approximately 8 times higher with the push method (OR 7.8; 95% CI, 5.01-12.25) than with the pull method [19,25,42,43] and was consistent in all studies, and heterogeneity testing did not show any significant variation between the studies(I 2 =17.1%). Some authors [2,40] investigated lateral and downward incisions separately and found that lateral extensions were more common than vaginal extensions if the push method was used.…”

“…In this method, after opening the uterus, the surgeon introduces a hand through the uterine incision towards the upper segment, grasps both feet, and gently pulls the fetus up to extract it through the uterine incision [25].…”

“…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].…”

“…Obstructed labor with the fetal head impacted in the pelvis is an obstetric complication that requires cesarean delivery with skilful handling in an organized manner to avoid serious maternal and neonatal sequel [25]. 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].…”

“…Although different techniques are described in the literature [25,29,30] The superiority of one technique over another is yet to be proven [29,31,32] (Table 1). …”