Reverse Breech Extraction at Cesarean Section in Second Stage of Labor

Abstract

The aim: Taking into consideration the increase in the frequency of urgent C-sections in the second stage of labor and significant technical difficulties in the extraction of deeply impacted fetal head during this operation, the aim of our work was to analyze the current published biomedical data to identify the optimal technical strategies for conducting this type of surgical interventions. Materials and methods: The search and analysis of current clinical data available in PubMed was performed. We analyzed 9 retrospective and randomized prospective studies with collected data from a total of 974 women (2002-2019). Conclusions: Analysis of nine prospective and retrospective studies, comparing reverse breech extraction with abdominovaginal technique, revealed a significant advantage and safety of reverse breech extraction. This procedure has been associated with the decrease of traumatic uncontrolled extension of uterine incisions in 2.3-10 times, the time of surgical intervention decreased by 6.5-33 minutes, and intraoperative blood loss was less by 149.5-444 ml as compared with abdominovaginal delivery. Moreover, less intra- and postoperative complications were observed. In conclusion, reverse breech extraction during cesarean section with impacted fetal head is a safe delivery technique that helps to significantly decrease the incidence of maternal complications.

Second Stage Cesarean Section

“…Impaction of the fetal head occurs when the station of head is below the level of ischial spines, and then onwards the delivery of the head becomes difficult. A deeply engaged head is hard to deliver and can cause difficulty [10]. A careful vaginal examination should be done before Cesarean section to ascertain the findings.…”