title: Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section.
abstract: OBJECTIVE
  To compare maternal and neonatal morbidity associated with two methods to extract the impacted fetal head during Cesarean delivery.
  
  
  METHODS
  We retrospectively analyzed cases with difficult extraction of the impacted fetal head during Cesarean section. We compared maternal and neonatal outcomes between cases that were delivered by head extraction following pushing through the vagina ('push' method) and those that were delivered by the reverse breech technique ('pull' method).
  
  
  RESULTS
  We reviewed 3105 Cesarean section reports. Difficult extraction necessitating the 'push' or 'pull' methods was noted in 48 (1.5%) instances. Women that were delivered by the 'pull' method had significantly lower rate of postpartum fever (5% versus 46%; odds ratios, 0.06; 95% confidence intervals, 0.007-0.51) and extensions of the uterine incision (15% versus 50%; odds ratio, 0.17; 95% CI, 0.04-0.74) compared to those that were delivered by the 'push' method. Neonatal outcomes were good in all cases.
  
  
  CONCLUSIONS
  In cases with difficult extraction of the impacted fetal head during Cesarean section, 'pull' method may result in lower maternal morbidity compared to the traditional 'push' method.
authors.affiliation: Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University School of Medicine, Jerusalem, Israel. roni1524@zahav.net.il
authors.forename: Roni
authors.initials: R
authors.lastname: Levy
authors.forename: Tamara
authors.initials: T
authors.lastname: Chernomoretz
authors.forename: Zvi
authors.initials: Z
authors.lastname: Appelman
authors.forename: Dan
authors.initials: D
authors.lastname: Levin
authors.forename: Yuval
authors.initials: Y
authors.lastname: Or
authors.forename: Zion J
authors.initials: ZJ
authors.lastname: Hagay
mesh_terms: D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006257:Head; D006801:Humans; D007231:Infant, Newborn; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D014710:Version, Fetal