Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods

Abstract

Obstructed labour is a common obstetric complication in Nigeria associated with poor fetal and maternal outcome. Delivery of the fetus at caesarean section is always difficult, especially if the fetal head is impacted in the pelvis. The mode of delivery at caesarean section may occasionally compound the morbidity associated with obstructed labour. The purpose of this study was to examine and compare the morbidity and mortality associated with two methods of delivery of the impacted fetal head at caesarean section for obstructed labour (the push method and the pull (reverse breech) method). This study is a prospective study of cases of obstructed labour admitted into the labour ward of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between 1 June 1998 and May 31 2000. One hundred and eight women with obstructed labour at term with live fetus undergoing caesarean section were assigned randomly to either of the methods of admission. The maternal and fetal outcomes were analysed and compared between groups. Patients in the push group had statistically significant higher rates of maternal morbidity (longer operation time, more blood loss, extension of uterine incision, endometritis, longer hospital stay and higher hospital bills) than the pull method (P < 0.05). Also the fetal morbidity was worse in the push group. The 'pull' method of delivery of impacted fetal head at caesarean section for obstruction is safer and faster than the 'push' method.

Pull Breech out versus Push Impacted Head up in Emergency Cesarean Section: A Comparative Study

“…This went in line with result of Kaima, et al 2011 [17]. But, in disagreement with Fasubaa et al 2002 who reported a higher postoperative infection rate in form of endometritis in the "push" method compared to reverse breech extraction. It seems logical that passage of the assistant's hand (who mostly is not part of the operating team) into the vagina can never be under sterile conditions, and therefore contamination of the operating field should be anticipated [18].…”

Fetomaternal Outcome in Second Stage Caesarean Section

“…11 Difficult delivery of impacted head may be facilitated by an assistant pushing from below or by using a reverse breech delivery. 12 In this study uterine incision extension as seen in 13.88%, which is slightly higher compared to the other studies may be due to head delivered by assistant pushing from below. 13 This might be because non-descent of the head with major caput and molding formation makes the delivery of the fetal head challenge.…”

Second Stage Cesarean Section

“…The pull method was associated with lesser blood loss than the push method (1257 ml versus898 ml) and lesser uterine wound extension (33% versus 11%). Though the incidence of low Apgar scores was lesser in the pull method, there was no increase in neonatal morbidity or death between groups [18]. Levy et al in a study compared both pull and push method.…”