International Federation of Gynecology and Obstetrics

Abstract: Objective: To compare the morbidity and mortality of 2 current techniques during cesarean delivery of an impacted fetal head.Methods: In a comparative setting, 59 pregnant women with obstructed labor due to impacted fetal head were recruited. The patients were categorized into 2 groups according to method of extraction: the “push” group (n=30) and the “pull” group (n=29). Uterus relaxants were used before cesarean in all cases and the incision was higher and wider than routine. Maternal and neonatal morbidities were compared between the groups.Results: Maternal complications in the push and pull groups were extension of the uterine incision (15 [50.0%] vs 5 [17.2%]); T or J incision (3 [10.0%] vs 4 [13.8%]); blood transfusion (3 [10.0%] vs 1 [3.4%]); wound infection (4 [13.3%] vs 1 [3.4%]); fever (16 [53.3%] vs 3 [10.3%]); and urinary tract infection (10 [33.3%] vs 0 [0.0%]). Incidences of extension of the uterine incision, fever, and urinary tract infection were significantly higher in the push group (P=0.008).Conclusion: Owing to a lower rate of abnormal incision and postpartum fever/infection with the pull method, this technique is preferable to the push method.

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