Background Second-stage caesarean section with a deeply impacted fetal head is associated with maternal and neonatal complications.Objectives 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.Search strategy Online searches of MEDLINE (1946( -January 2015, EMBASE (1950-January 2015, Web of Sciences (1950, and the Cochrane Library databases were performed using a set of relevant keywords.Selection criteria All studies that compared the outcome of various techniques of delivering the baby's head at full-dilation caesarean section.Data collection and analysis 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.Main 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.Authors' conclusions Evidence gathered from observational studies suggests that reverse breech extraction is associated with significantly lower maternal risks compared with the push method.Keywords Impacted fetal head, push method, reverse breech extraction, second-stage caesarean section.Tweetable abstract Meta-analysis suggests reverse breech extraction during caesarean section to deliver impacted fetus is safer.Please cite this paper as: Jeve YB, Navti OB, Konje JC. Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis. BJOG 2016;123:337-345.

Current evidence suggests that male circumcision may be protective among MSM who practice primarily insertive anal sex, but the role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined. Therefore, there is not enough evidence to recommend male circumcision for HIV prevention among MSM at present. Further research should be of high quality and further explore interaction with the predominant sexual role.

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Suspected cases of arthrogryposis require multi-disciplinary management to optimise the possibility of making a diagnosis and providing parents with accurate information to enable them to make informed choices regarding the pregnancy and providing information regarding likelihood of recurrence.