Reverse breech extraction versus head pushing in cesarean section for obstructed labor. A comparative study in Yemen.

OBJECTIVES: To compare the maternal and fetal outcome of 2 different methods of delivering the baby during cesarian section when the fetal head is deeply engaged.

METHODS: A prospective case control study was carried out in the Obstetrics and Gynecology Department, Al-Thawra General Hospital, Sana'a, Yemen from January to December 2010. A total of 118 women who met our criteria were included in the study. They were divided randomly into 2 groups. A study group (n=59) was assigned to deliver the baby by reverse breech extraction, and control group (n=59) was assigned to deliver by the conventional method. The maternal and neonatal outcomes between the 2 groups were compared.

RESULTS: Extension of the uterine incision occurred in significantly less women using reverse breech extraction compared to cephalic delivery (5% versus 40.6%; p=0.0001). It was observed that the mean operation time and blood loss in the study group were lower than that in the control group (52.9 ± 5.1, 787 ± 519 versus 67.2 ± 4.7, 1231 ± 471; p<0.0001). No significant difference between groups was noted in the maternal and neonatal outcomes.

CONCLUSIONS: Reverse breech extractions is an attractive and safe alternative to the standard method for intraoperative disengagement of a deeply impacted fetal head in order to reduce maternal and fetal morbidly.