DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20151603

Disengagement of the deeply engaged fetal head during caesarean section in advanced labor: patwardhan versus push extraction

Beeresh C. S., Divyasree Doopadapalli, Pradeep Shivaraju, Krishna Lingegowda

Abstract


Background: To compare the maternal and neonatal morbidities between the “Patwardhan” technique and the “Push” method for extraction of the foetus in second stage caesarean sections.

Methods: Retrospective cohort study was done at PESIMSR, Kuppam, AP from MAY 2012 to APRIL 2015. Women with single fetus at term in anterior vertex position, with the head deeply impacted in pelvis and needing cesarean delivery where included in the study.  Group 1 consists of all cases in which extraction of fetus was done by Patwardhan technique and Group 2, in whom extraction of fetus was done by push method and extracted as vertex. Objective of the study was to assess selective complications like extension of the incision, injury to the surrounding structures, excessive bleeding, need for blood transfusion and the fetal outcome between the two groups.

Results: Out of 98 cases reviewed, 46 belonged to group A (Patwardhan) and 52 belonged to group B (push). Patients in the push group had statistically significant higher rates of maternal morbidity in terms of uterine extension and other related complications. However; there were no differences in neonatal outcomes in both the groups.

Conclusions: While complications are inherent in both methods, Patwardhan method of delivery of the fetus for second stage labour has been shown to confer considerable advantage in prevention of maternal morbidity over the push method in our institution. Our findings support the fact that the Patwardhan method could be a useful maneuver in intraoperative disengagement of fetal head, when encountered at second stage CS and it is our opinion that the Patwardhan manoeuvre can be practiced selectively as a primary technique.

 


Keywords


Second stage caesarean section, Deeply engaged fetal head, Patwardhan technique, Push method

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References


ACOG. Fact sheet: Evaluation of cesarean delivery, 2000. Available at http://archive.poughkeepsiejournal.com/assets/pdf/BK15725757.PDF. Accessed on 20th Sep 2015.

Singh M, Varma R. Reducing complications associated with a deeply engaged head at caesarean section: A simple instrument. The Obstetrician & Gynaecologist. 2008;10:38-41.

Chhabra S, Gandhi D, Jaiswal M. Obstructed labour – a preventable entity. J Obstet Gynaecol. 2000;20:151-53.

Hager RM, Daltviet AK, Hofoss D, Nilson ST, Oian P, Henriksen T. Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol. 2004;190:428-34.

Murphy DJ, Liebling RE, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001;358:1203-7.

Sung JF, Daniels KI, Brodzinsky L, El-Sayed YY, Caughey AB, Lyell DJ. Caesarean delivery outcome after a prolonged second stage of labor. Am J of Obstet Gynecol. 2007;197:306:1-5.

Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY. Comparison of maternal and fetal outcome from primary caesarean delivery during the second compared with the first stage of labor. Obstet Gynecol. 2007;109:917-21.

Lippert TH. Abdominovaginal delivery in case of impacted head in cesarean section operation. Am J Obstet Gynecol. 1985;151(5):703.

Landesman R, Graber EA. Abdominovaginal delivery: modification of the cesarean section operation to facilitate delivery of the impacted head. Am J Obstet Gynecol. 1984;148(6):707.

Fong YF, Arulkumaran S. Breech Extraction – an alternative method of delivering a deeply engaged head at cesarean section. International Journal of Obstetrics and Gynaecology. 1997;56:184-4.

Patwardhan BD, Motashaw ND. Caesarean Section. J Obstet Gynecol India. 1957;8:1-15.

Murray Utah. Clinical Innovations. C-snorkel: Impacted Fetal Head Release Device by Softlift. 2012. Available at [http://www.clinicalinnovations.com/portfolio-items/c-snorke]. Accessed on 20th sep 2015.

Yifru Berhan, Asres Berhan. A metaanlysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery. International journal of gynecology and obstetrics. 2014;124:99-105.

Schwake, Petchenkin, Younis. Reverse breech extraction in cases of second stage caesarean section. Journal of Obstetrics and Gynaecology. 2012;32:548-51.

Blickstein I. Difficult delivery of the impacted fetal head during caesarean section: intraoperative disengagement dystocia. J Perinat Med. 2004;32:465-9.

Kafali H. Cesarean breech extraction for impacted fetal head in deep pelvis after a prolonged obstructed labour: a cesarean technique variation. Internet J Gynaeco. 2003;2-5.

Fasubaa OB, Ezechi OC, Orji EO, Ogunniyi SO, Akindlele ST, Loto OM et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: A randomised comparative study of the two methods. J Obstet Gynaecol. 2002;22:375-8.

Chopra S, Bagga R, Keepanasseril A, Jain V, Kalra J, Suri V. Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: conventional method versus reverse breech extraction. Acta Obstet Gynecol Scand. 2009;88:1163-6.

Loudon JAZ, Groom KM, Hinkson L, Harrington D, Paterson-Brown S. Changing trends in operative delivery performed at full dilatation over a 10-year period. J Obstet Gynaecol. 2010;30:370-5.

Rhadha P, Tagore S, Rahman MFA, Tee J. Maternal and perinatal morbidity after caesarean delivery at full cervical dilatation. Singapore Med J. 2012;53:655-8.

Khosia AH, Dahiya K, Sangwan K. Cesarean section in a wedged head. Ind J Med Sci. 2003;57:187-91.

Mukhopadhyay P, Naskar T, Dalui R, Hazra S, Bhattacharya D. Evaluation of Patwardhan’s technic – a four year study in a rural teaching hospital. J Obstet Gynecol India. 2005;55:244-6.

Pradip Kumar Saha et al., Second Stage Caesarean Section: Evaluation of Patwardhan Technique. Journal of Clinical and Diagnostic Research. 2014;8(1):93-5.

Ajith virkud. Video clip: Patwardhan manoeuvre. Available at YouTube- https://www.youtu.be/nvpBfz960do.Accessed on 20th sep 2015.