Reverse breech extraction versus the standard approach of pushing the impacted fetal head up through the vagina in caesarean section for obstructed labour: A randomised controlled trial

Nooh, Ahmed Mohamed; Abdeldayem, Hussein Mohammed; Ben-Affan, Othman

doi:10.1080/01443615.2016.1256958

Cited by 22 publications

(34 citation statements)

References 16 publications

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“…Ideally, such a dilemma should be more adequately answered by a randomised controlled trial. However, previously reported randomised trials 8,[12][13][14] were of significantly smaller sample size. Taking into consideration the rate of failed cephalic extractions in our study, we would have expected at least a few cases in which final extraction was performed not according to randomisation.…”

Section: Discussionmentioning

confidence: 99%

“…4,7 Available data seem to favour the breech method. [8][9][10][11] A small randomised control trial of 192 women showed a significantly lower risk for maternal morbidity including uterine incision extensions, need for blood transfusion, postpartum fever, wound infection and lower rate of low Apgar score at 5 minutes using breech versus cephalic extraction. 8 Another retrospective study showed a significantly lower rate of postpartum fever and uterine incision extensions in breech extraction 9 a meta-analysis including 11 studies, 6 prospective and 5 retrospective, concluded that the overall perinatal mortality was higher in the cephalic extraction.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] A small randomised control trial of 192 women showed a significantly lower risk for maternal morbidity including uterine incision extensions, need for blood transfusion, postpartum fever, wound infection and lower rate of low Apgar score at 5 minutes using breech versus cephalic extraction. 8 Another retrospective study showed a significantly lower rate of postpartum fever and uterine incision extensions in breech extraction 9 a meta-analysis including 11 studies, 6 prospective and 5 retrospective, concluded that the overall perinatal mortality was higher in the cephalic extraction. 10 Another meta-analysis including 12 studies, 3 prospective and 9 retrospective, comparing different extraction techniques (push technique, breech extraction, Patwardhan method and fetal pillow), showed that the risks of uterine incision extension, infection, mean blood loss and operative time were significantly higher with the push technique than with the breech extraction technique.…”

Section: Introductionmentioning

confidence: 99%

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Cephalic extraction versus breech extraction in second‐stage caesarean section: a retrospective study

Ezra

Lahav-Ezra

Meyer

et al. 2020

BJOG

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Objective Our primary objective was to compare maternal and neonatal outcomes based on the attempted mode of extraction. Our secondary objective was to compare the outcomes based on the actual mode of extraction. Design A retrospective cohort study at a single tertiary centre between the years 2011 and 2019. Setting The study included 1028 cases of term pregnancies in vertex presentation that were delivered by caesarean section at the second stage of delivery. Population Patients were grouped according to the attempted mode of extraction: attempted cephalic extraction (674) and breech extraction (354). A subgroup analysis was conducted, comparing successful cephalic extraction (615), failed cephalic extraction (59) and breech extraction (354). Methods Both maternal and neonatal complication rates were compared between the groups. Results There were significantly more uterine incision extensions (27.4 versus 11.9%, P < 0.001) and increased need for blood transfusion (10.7 versus 6.2%, P = 0.018) in the cephalic Conclusions Breech extraction in second-stage caesarean section is associated with fewer maternal complications compared wiith attempted cephalic extraction without increasing neonatal complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cephalic extraction versus breech extraction in second‐stage caesarean section: a retrospective study

Ezra

Lahav-Ezra

Meyer

et al. 2020

BJOG

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“…Analysis of published data demonstrating the incidence of unintended extension of uterine incision following application of reverse breech extraction (RBE) vs. abdominovaginal (AV) method. [10,18,19,20,21,22,23,24,25].…”

Section: Methodsmentioning

confidence: 99%

“…Although this technique is widely used in different countries of the World, it is less known in Ukraine, and unfortunately almost not mentioned in Ukrainian studies and clinical protocols. All randomized clinical investigations performed in different countries demonstrated significant advantages and safety of reverse breech extraction technique (pull method) as compared with abdominovaginal (push method) [18,19,20,21] (Table I).…”

Section: Methodsmentioning

confidence: 99%

Reverse Breech Extraction at Cesarean Section in Second Stage of Labor

2020

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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.

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Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study

Peled,

Muraca,

Ratner

et al. 2024

Intl J Gynecology & Obste

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ObjectiveSecond‐stage cesarean delivery (CD) is associated with subsequent preterm birth (PTB). It has been suggested that an increased risk of PTB after second‐stage cesarean delivery could be linked to a higher chance of cervical injury due to the extension of the uterine incision. Previous studies have shown that reverse breech extraction is associated with lower rates of uterine incision extensions compared to the “push” method.We aimed to investigate the association between the method of fetal extraction during second‐stage CD and the rate of spontaneous PTB (sPTB), as well as other maternal and neonatal outcomes during the subsequent pregnancy.MethodsThis was a multicenter retrospective cohort study. The study population included women in their first subsequent singleton delivery following a second‐stage CD between 2004 and 2021. The main exposure of interest was the method of fetal extraction in the index CD (“push” method vs. reverse breech extraction). The primary outcome of this study was sPTB <37 weeks in the subsequent pregnancy. Secondary outcomes were overall PTB, trial of labor, and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling.ResultsDuring the study period, 2969 index CD during second stage were performed, of those 583 met the inclusion criteria, of whom 234 (40.1%) had fetal extraction using the reverse breech extraction method, while 349 (59.9%) had the “push” method for extraction. In univariate analysis, women in those two groups had statistically similar rates of sPTB (3.7% vs. 3.0%; odds ratio [OR] 1.25, 95% CI: 0.49–3.19) and overall PTB (<37, <34 and <32 weeks), as well as other maternal, neonatal, and trial of labor outcomes. This was confirmed by multivariate analyses with an adjusted OR of 1.27 (95% CI: 0.43–3.71) for sPTB.ConclusionAmong women with a previous second‐stage CD, no significant difference was observed in PTB rates in the subsequent pregnancies following the “push” method compared to the reverse breech extraction method.

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Reverse breech extraction versus the standard approach of pushing the impacted fetal head up through the vagina in caesarean section for obstructed labour: A randomised controlled trial

Cited by 22 publications

References 16 publications

Cephalic extraction versus breech extraction in second‐stage caesarean section: a retrospective study

Cephalic extraction versus breech extraction in second‐stage caesarean section: a retrospective study

Reverse Breech Extraction at Cesarean Section in Second Stage of Labor

Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study

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