Maternal and neonatal outcome of reverse breech extraction of an impacted fetal head during caesarean section in advanced stage of labour: a retrospective cohort study

Abstract

Background Caesarean section with extraction of a deeply impacted fetal head is technically challenging and is associated with serious maternal and neonatal complications. The purpose of the study was to identify risks and evaluate selected outcome parameters associated with difficult fetal head extraction during caesarean section in advanced labour comparing two different extraction techniques (head pushing vs. reverse breech). Methods This retrospective cohort study was conducted at the Division of Obstetrics in a tertiary care hospital in Zurich, Switzerland. 629 women at term with a singleton pregnancy in cephalic presentation during advanced intrapartum caesarean section from December 2012 until December 2016 were evaluated. Primary outcome was the incidence of uterine incision extensions. Secondary outcomes were other selected maternal and neonatal outcome parameters. Data analysis was performed using SPSS with Mann-Whitney U independent sampling test and two-tailed Fisher’s exact test ( p < 0.01). Results Difficult fetal head extractions are associated with significantly elevated maternal and neonatal risks. When performed by reverse breech technique, significant lower rates of extensions of the uterine incision, shorter operation times and less operative blood loss were identified compared to the head pushing method. No statistically significant differences for the neonatal outcomes were described so far. However, among the group of difficult fetal delivery with the head pushing method two neonates had perinatal skull fractures, with one of those resulting in neonatal death. Conclusions The head pushing method is associated with higher maternal morbidity than the reverse breech method for extraction of a deeply engaged fetus during intrapartum caesarean section in advanced stage of labour.

Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients

“…The histogram of SAP timing relative to incision demonstrates that peak administration after incision is slightly delayed, compatible with administration after clamping (Fig. 2 ) and reflecting the time interval between incision and cord clamping, which usually is well below 10 min [ 20 ]. The median age of the participants was 33 years [IQR 29–36] and in 21.8% the wound class was considered contaminated.…”

“…Several subgroup analyses were performed: First, two subgroup analyses were performed to ensure that administration of SAP after incision actually corresponded to administration after clamping, i.e., within 2–8 min [ 20 ]: For this reason, we first excluded cases with SAP administration in the 10 min after incision. The second subgroup excluded hospitals with variable SAP administrations before/after clamping.…”

“…Recent data, including a large randomized trial, from general and cardiac surgery showed that administration of SAP very close to incision was not associated with an increased risk of SSI [ 18 , 19 ]. The time interval between incision and cord clamping is around 2–8 min [ 20 ], a very short period to assume a huge difference in the risk of SSI between the two strategies.…”

Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor

“…Gentle traction on both legs is performed by which the body is delivered followed by the head which is disengaged from the maternal pelvis. They showed the reverse breech technique to be correlated with lower uterine incision extension rate, shorter operation times and less operative blood loss compared to the push method . There is lack of knowledge regarding which technique of reverse breech extraction encompasses more favorable results.…”

Reverse Breech Extraction at Cesarean Section in Second Stage of Labor

“…Analysis of published data demonstrating the incidence of unintended extension of uterine incision following application of reverse breech extraction (RBE) vs. abdominovaginal (AV) method. [10,18,19,20,21,22,23,24,25].…”