The incidence of second-stage Caesarean sections is greater in developing countries, where children are delivered to their homes by traditional birth attendants. The second stage cesarean represents a quarter of all primary cesarean sections 1 . Caesarean sections with complete cervical dilatation with impacted fetal heads are technically difficult because the inferior segment is thinned and edematous and therefore associated with an increased incidence of maternal and fetal morbidity 2 Delivery of the impacted fetal head in the second stage is technically difficult, and it is a main factor contributing to the associated increased complications 3 . The risks of postpartum maternal complications directly correlate with the duration of the second stage of labour and the mode of delivery 4 .The Patwardhan technique is a unique technique that was introduced by Dr. Patwardhan in 1957 to facilitate delivery of the head deeply affected in caesarean sections of the second stage and have fewer maternal and fetal pathologies. .Many women are referred from the periphery in advanced stages of obstructed labour to our hospital. Extraction and delivery of the fetal head in this situation can be achieved utilizing either abdomino-vaginal approach with head pushing up from the vagina 5 or Patwardhan technique, where the infant's shoulders are delivered first, then the trunk, breech, limbs and finally the head . So this study was undertaken to compare Patwardhan's technique with the push method and also to evaluate the safety of Patwardhan's technique. Material and Methods:-It is a prospective study including all caesarean sections done in second stage at Tertiary care centre, Haldwani. Patients were divided into two groups: group -1 where baby delivered by Patwardhan technique and group 2 where baby delivered by push technique. Both groups were compared in terms of maternal outcomes as uterine incision extensions, PPH, blood transfusions and neonatal outcomes in terms of their weight, APGAR and NICU stay. Inclusion criteria:Patient with single fetus at term in vertex presentation with full cervical dilatation with deeply impacted fetal head in maternal pelvis. Exclusion criteria:1. Multiple pregnancies 2. Previous caesarean section/myomectomy 3. Antepartum haemorrhage 4. Pregnancy less than 37 weeks
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