Comparison of Perinatal Outcomes of two Methods to Assist Delivery for Impacted Fetal Head at Cesarean Birth

Abstract

ABSTRACT:

Background: Impacted fetal head is a challenging obstetrical situation at second stage cesarean births. Among different techniques, Reverse breech extraction and conventional head push techniques are the two widely used techniques.

Objective: To compare perinatal outcomes of breech extraction method Vs head push technique to assist delivery for impacted fetal head at cesarean birth

Material and Methods: This comparative cross-sectional study was conducted in the Gynea Department, Lady Reading Teaching Hospital, Peshawar, from 1st Feb 2019 till 31 Jan 2022. A total of 170, patients with alive fetus, cephalic presentation, undergoing second stage cesarean sections with deeply impacted fetal head and with baby delivered either via push up technique or reverse breech extraction technique were included in the study. Patients were divided in to two equal groups based on the technique of fetal delivery. The two groups were compared for perinatal outcomes of Low APGAR score, NICU admissions and early neonatal deaths.

Results: Of the total 170 patients, 85 were in each group. Mean age was 29.66±4.41, with range from 18 to 40 years. Sixty-one (61%) percent women were multiparas and 39% were primiparas. Mean gestational age of study participants was 39.42 ± 1.37. Statistically significant difference was observed between Group II (reverse breech extraction) and Group I (standard head push) for low APGAR score (<7/10) at 5 minutes i.e. 13 (13.29%) vs 26 (30.59%) (p-0.018). Neonatal intensive care admission rate was 24 % for Group II and 38% for Group I (p-0.066).The difference in neonatal death between two groups was not statistically significant, i.e. 4% vs 6% (p-0.77).

Conclusion: Reverse breech extraction technique has the advantage over conventional head push technique in term of reduced rates of low APGAR scores at 5 minutes of birth