title: Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: conventional method versus reverse breech extraction.
abstract: Maternal and fetal morbidity of two different methods of delivering the baby during cesarean section performed in advanced labor when the fetal head is deeply engaged was assessed retrospectively, i.e. delivering as 'cephalic' with or without assistance to push up the fetal head from the vagina (head first or push method) and 'reverse breech extraction' (feet first or pull method). Records of 182 women with a single fetus in cephalic presentation, who had undergone cesarean section at cervical dilatation at > or =7 cm, with the vertex at or below zero station, were reviewed. Extension of the uterine incision occurred in significantly more women during 'cephalic' delivery as compared to 'reverse breech extraction' (22.8% versus 2.2%; p=0.001). Use of 'reverse breech extraction' is an attractive and safe alternative to the standard methods for intra-operative disengagement of a deeply impacted fetal head in order to reduce maternal and fetal morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education & Research (PGIMER), Sector-12, Chandigarh, 160012, India. drseemachopra@yahoo.com
authors.forename: Seema
authors.initials: S
authors.lastname: Chopra
authors.forename: Rashmi
authors.initials: R
authors.lastname: Bagga
authors.forename: Anish
authors.initials: A
authors.lastname: Keepanasseril
authors.forename: Vanita
authors.initials: V
authors.lastname: Jain
authors.forename: Jasvinder
authors.initials: J
authors.lastname: Kalra
authors.forename: Vanita
authors.initials: V
authors.lastname: Suri
mesh_terms: D001034:Apgar Score; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D011247:Pregnancy; D012189:Retrospective Studies