title: Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Second-stage caesarean section with a deeply impacted fetal head is associated with maternal and neonatal complications.
  
  
  OBJECTIVE
  Systematic review and meta-analysis to identify, appraise and synthesise existing evidence that evaluated various techniques of delivering a baby with a deeply impacted head at full-dilation caesarean section. The primary outcome was uterine extension and secondary outcomes were other maternal and neonatal morbidities.
  
  
  METHODS
  Online searches of MEDLINE (1946-January 2015), EMBASE (1950-January 2015), Web of Sciences (1950-2015), and the Cochrane Library databases were performed using a set of relevant keywords.
  
  
  METHODS
  All studies that compared the outcome of various techniques of delivering the baby's head at full-dilation caesarean section.
  
  
  METHODS
  Methodological quality was assessed using the Newcastle-Ottawa scale. Data collected from each of the studies included variables on the participants, comparisons used, and feto-maternal outcomes. Meta-analysis was performed using review manager 5.3.
  
  
  RESULTS
  In total, 12 studies were included. Six studies (n = 455) examined primary outcomes. Meta-analysis showed that the risks of uterine incision extension, infection, mean blood loss, and operative time were significantly higher with the push technique compared with the reverse breech extraction. The evidence to support the Patwardhan method and fetal pillow was inadequate.
  
  
  CONCLUSIONS
  Evidence gathered from observational studies suggests that reverse breech extraction is associated with significantly lower maternal risks compared with the push method.
  
  
  CONCLUSIONS
  Meta-analysis suggests reverse breech extraction during caesarean section to deliver impacted fetus is safer.
authors: Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK.
authors: Y B
authors: YB
authors: Jeve
authors: Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK.
authors: O B
authors: OB
authors: Navti
authors: Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK.|Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, University of Leicester, Leicester, UK.|Center of Excellence in Reproductive Sciences, Department of Obstetrics and Gynecology, Sidra Medical and Research Center, Doha, Qatar.
authors: J C
authors: JC
authors: Konje
mesh_terms: D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005333:Fetus; D006257:Head; D006801:Humans; D007747:Labor Stage, First; D007744:Obstetric Labor Complications / Q000628:therapy*; D011247:Pregnancy
keywords: Impacted fetal head; push method; reverse breech extraction; second-stage caesarean section