Selection of fetal extraction method at cesarean section in the second stage of labor

• Evgeny Kh. Tazhetdinov

Abstract

Caesarean section has become the most common operation in the world today. Second-stage caesarean section with a deeply impacted fetal head is associated with maternal and neonatal complications. Two methods are most often used to overcome difficulties associated with removing the fetal head: the first-is the standard approach or the "push" method and the second method is the alternative approach is the "pull" method or "reverse breech extraction". 158 women and their newborns (the "pull" group - 77 patients, the "push" group - 81 patients) were included into the study. Inclusion criteria: one-pregnancy; fetal head presentation; gestational age 37-42 weeks; full cervical dilatation. The aim of our study was to identify the most effective and safe method for fetal extraction with cesarean section in the second stage of labor.

The primary criterion of the safe was trauma to the lower uterine segment. Secondary assessment criteria included: cervical trauma, intraoperative and postoperative blood loss, degree of mother's hemoglobin in the postoperative period, postoperative hospital bed day, Apgar score on the 1^st and 5^th minute, admission to the neonatal intensive care unit.

Trauma of the Lower segment in the "push" group was recorded in 12.3%, the "pull" group, significantly Less - in 7.8% (p=0.029)

The "reverse breech extraction" is a more effective and safer than the standard approach ("push" method) according to data of our study.

Keywords:second stage of labor, caesarean section at full dilatation, "push" method, reverse breech extraction, impacted fetal head

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