title: A meta-analysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery.
abstract: BACKGROUND
  During cesarean delivery, extracting a deeply impacted head is a real challenge for obstetricians.
  
  
  OBJECTIVE
  To compare selected maternal and fetal outcome indicators of the "pull" (reverse breech extraction) and "push" methods for impacted fetal head extraction during cesarean delivery.
  
  
  METHODS
  A computer-based search of the Medline, Cochrane library, and HINARI databases.
  
  
  METHODS
  Studies that compared the maternal and perinatal outcomes of the push and pull methods for impacted fetal head extraction during cesarean delivery were included.
  
  
  METHODS
  A meta-analysis of Mantel-Haenszel odds ratios and standardized mean differences from 11 randomized comparative and retrospective cohort studies was performed.
  
  
  RESULTS
  In the pooled analysis, the risk of uterine incision extension was more than 8 times higher with the push method than with the pull method. Blood loss and operation time were also increased with the push method, and this method was associated with more perinatal deaths and admissions to the neonatal intensive care unit. The risk of wound infection was not significantly different between the 2 methods.
  
  
  CONCLUSIONS
  The present meta-analysis demonstrated marked reductions in uterine incision extension, blood loss, and operation time with reverse breech extraction.
authors.affiliation: Department of Obstetrics and Gynecology, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia. Electronic address: yifrub@yahoo.com.
authors.forename: Yifru
authors.initials: Y
authors.lastname: Berhan
authors.affiliation: Department of Pharmacology, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.
authors.forename: Asres
authors.initials: A
authors.lastname: Berhan
mesh_terms: D016063:Blood Loss, Surgical; D001946:Breech Presentation / Q000601:surgery*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D014599:Uterus / Q000601:surgery
keywords: Cesarean delivery; Impacted fetal head; Meta-analysis; Push method; Reverse breech extraction