“COMPARISON OF PULL BREECH OUT AND PUSH IMPACTED HEAD UP TECHNIQUES USED TO DELIVER A DEEPLY IMPACTED FOETAL HEAD AT FULL DILATATION IN EMERGENCY CAESAREAN SECTION”
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Keywords
pull breech extraction, caesarean section, impacted foetal head, uterine incision, push impacted head up
Abstract
Background: Caesarean section (CS) is among the most common significant procedures in obstetrics. A range of techniques is employed to assist in the extraction of an impacted fetal head (IFH) during emergency CS. This study aimed to compare pull breech extraction and push strategies for delivering a profoundly engaged infant at full dilation during emergency cesarean sections.
Materials and Methods: This randomized clinical trial (RCT) was conducted in the department of gynecology and obstetrics at Holy Family Hospital, Rawalpindi. Sixty-two women, aged 18-40 years, having obstructive labour requiring CS were included in the study. Women with a prior uterine scar were eliminated. Women in group A (n = 31) underwent delivery with reverse breech extraction, whilst those in group B (n = 31) were delivered using the head push approach. Outcome measures comprised surgical duration, uterine incision extension, and hemorrhage volume.
Results: Women who participated in this study were aged 30.16 ± 4.95 years in group A and 30.48 ± 4.65 years in group B. Average period of gestational age was 39.34 ± 1.62 weeks. Operative duration for group A (reverse breech extraction group) and group B (head push method group) was 57.52 ± 6.69 minutes and 69.90 ± 9.32 minutes respectively (p-value = 0.0001). Blood loss measured as the 593.58 ± 92.12 ml in group A while group B experienced 996.01 ± 105.98 ml hemorrhage (p-value = 0.0001). The rate of extended uterine incision reached 6.45% in group A while group B experienced 25.81% (p-value = 0.035).
Conclusion: Pull breech out method is superior push technique for delivering a deeply IFH at full dilatation in emergency CS.
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Sobia Nawaz
MBBS; FCPS, Associate Professor of Gynae.DHQ Teaching Hospital, RawalpindiSaima Bibi
MBBS; FCPS Assistant Professor of Gynae. Holy Family Hospital, RawalpindiSarah Ejaz
MBBS; FCPS Senior Registrar Gynae. Holy Family Hospital, RawalpindiToheeda Shaheen
Consultant Gynecologist Medicare Hospital, RawalpindiRabia Noor
Resident Gynae. Obs.Nabeela Waheed
Ex. Professor of Gynae. Holy Family Hospital, Rawalpindi