title: A simple device prevents hysterotomy extensions during cesarean delivery for failed second stage of labor.
abstract: OBJECTIVE
  [corrected] During arrest of descent, maternal tissues conform to the fetal head, resulting in a suction-cup like effect during cesarean delivery. We hypothesize that breaking this suction might ease delivery. A novel device was designed for this purpose and tested in this series of 23 patients.
  
  
  METHODS
  University-based retrospective cohort feasibility study. Term pregnant women with second-stage labor arrest (n = 23) provided written consent for use of the experimental device, inserted vaginally prior to cesarean delivery. Delivering obstetricians rated device effectiveness. Following case collection, the presence of hysterotomy extensions in study patients was retrospectively compared with controls (n = 49) from the same study period.
  
  
  RESULTS
  On a 7-point Likert scale, consultant obstetricians rated overall device effectiveness as 6.0, and resident obstetricians rated it 6.3, consistent with a moderate improvement in ease of delivery. The device performed optimally at mid-pelvic stations (0 to +1), with no hysterotomy extensions (n = 0/17), which was significantly better than controls (n = 14/41, 34%, p < 0.01).
  
  
  CONCLUSIONS
  A simple device prevented hysterotomy extension during second-stage cesarean delivery at 0 and +1 station. Obstetricians perceived that the device afforded a moderate improvement in delivery compared with previous deliveries in which the device was not used.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, Columbia, Mo., USA.
authors.forename: Breton F
authors.initials: BF
authors.lastname: Barrier
authors.forename: Jana L
authors.initials: JL
authors.lastname: Allison
authors.forename: Clark O
authors.initials: CO
authors.lastname: Andelin
authors.forename: Erma Z
authors.initials: EZ
authors.lastname: Drobnis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000295:instrumentation*; D004420:Dystocia / Q000601:surgery*; D005260:Female; D006801:Humans; D020883:Hysterotomy; D007746:Labor Presentation; D007748:Labor Stage, Second; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult