title: Reverse breech extraction versus the standard approach of pushing the impacted fetal head up through the vagina in caesarean section for obstructed labour: A randomised controlled trial.
abstract: The objective of this study was to assess effectiveness and safety of the reverse breech extraction approach in Caesarean section for obstructed labour, and compare it with the standard approach of pushing the fetal head up through the vagina. This randomised controlled trial included 192 women. In 96, the baby was delivered by the 'reverse breech extraction approach', and in the remaining 96, by the 'standard approach'. Extension of uterine incision occurred in 18 participants (18.8%) in the reverse breech extraction approach group, and 46 (47.9%) in the standard approach group (p = .0003). Two women (2.1%) in the reverse breech extraction approach group needed blood transfusion and 11 (11.5%) in the standard approach group (p = .012). Pyrexia developed in 3 participants (3.1%) in the reverse breech extraction approach group, and 19 (19.8%) in the standard approach group (p = .0006). Wound infection occurred in 2 women (2.1%) in the reverse breech extraction approach group, and 12 (12.5%) in the standard approach group (p = .007). Apgar score <7 at 5 minutes was noted in 8 babies (8.3%) in the reverse breech extraction approach group, and 21 (21.9%) in the standard approach group (p = .015). In conclusion, reverse breech extraction in Caesarean section for obstructed labour is an effective and safe alternative to the standard approach of pushing the fetal head up through the vagina.
authors.affiliation: a Obstetrics and Gynaecology Department , Zagazig University Students' Hospital , Zagazig , Egypt.
authors.forename: Ahmed Mohamed
authors.initials: AM
authors.lastname: Nooh
authors.affiliation: b Obstetrics and Gynaecology Department , Zagazig University Faculty of Medicine , Zagazig , Egypt.
authors.forename: Hussein Mohammed
authors.initials: HM
authors.lastname: Abdeldayem
authors.affiliation: c Obstetrics and Gynaecology Department , Al-Ahrar District General Hospital , Zagazig , Egypt.
authors.forename: Othman
authors.initials: O
authors.lastname: Ben-Affan
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section / Q000379:methods*; D004420:Dystocia; D005113:Extraction, Obstetrical / Q000379:methods*; D005260:Female; D006257:Head; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D011247:Pregnancy; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014621:Vagina; D055815:Young Adult
keywords: Reverse breech extraction; caesarean section; impacted fetal head; obstructed labour