Maternal and neonatal outcomes associated with delivery techniques for impacted fetal head at cesarean section: a systematic review and meta-analysis

Abstract

Objectives Late first-stage or second-stage cesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-analysis was to compare maternal and neonatal outcomes associated with delivery techniques via cesarean section. Methods An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomised comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during cesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses. Results Nineteen articles, including 2,345 women were analyzed. Three fetal extraction techniques were identified. Meta-analyses showed that the “pull” technique carries lower risks as compared to the “push” technique and the “Patwardhan” technique is safer compared to the “push” or the “push and pull” technique. Conclusions In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the “pull”, as well as the “Patwardhan” technique represent safe options to deliver an impacted fetal head.

RETRACTED: Management of Impacted Fetal Head at Caesarean Birth

“…Findings from this systematic review align with other systematic reviews 2,3,65,66 suggesting that ‘pull’ methods, including reverse breech extraction and Patwardhan method, may be associated with improved maternal outcomes compared with the ‘push’ method, but with very low certainty. However, the evidence base for the effectiveness of different methods of managing IFH at CB is very limited and the studies have multiple weaknesses.…”

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study

“…It is therefore not possible to practice reverse breech extraction. However, there is increasing evidence that reverse breech methods may be safer for women undergoing CS when an IFH occurs 3,4,33 . Despite this, many UK obstetric trainees are not confident performing it 14 .…”

“…However, there is increasing evidence that reverse breech methods may be safer for women undergoing CS when an IFH occurs. 3 , 4 , 33 Despite this, many UK obstetric trainees are not confident performing it. 14 Participants in this study performed reverse breech extraction in nearly one‐quarter of simulated scenarios.…”

Management of impacted fetal head at cesarean delivery

“…Over the last decade, 3 systematic reviews and meta-analyses have compared maternal and neonatal outcomes according to the type of disimpaction technique. 19 , 42 , 60 The most recent systematic review published in 2022 included 7 prospective randomized studies and 12 observational studies, with 9 of 11 cohort studies meeting the Critical Appraisal Skills Programme (CASP) criteria and 8 of 10 RCTs fully meeting the CASP criteria. 60 …”

“… 19 , 42 , 60 The most recent systematic review published in 2022 included 7 prospective randomized studies and 12 observational studies, with 9 of 11 cohort studies meeting the Critical Appraisal Skills Programme (CASP) criteria and 8 of 10 RCTs fully meeting the CASP criteria. 60 …”