Reverse Breech Extraction versus Vaginal Push before Uterine Incision during Cesarean Section with Fully Dilated Cervix and Impacted Fetal Head

IF 0.1 Q4 OBSTETRICS & GYNECOLOGY
Elshamy Elsayed, Sharaf Abdelbar, Shaheen Abdelhamid
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Abstract

Purpose: To compare between the two commonly used methods to deliver the fetus in emergency cesarean section with fully dilated cervix and impacted fetal head; vaginal push up of the fetal head and reverse breech extraction regarding safety and efficacy. Methods: A retrospective observational study was conducted 152 women underwent emergency CS with fully dilated cervix and impacted fetal head were divided into two groups; Group 1, vaginal push (n = 96) and Group 2, reverse breech delivery (n = 56). Data variables were collected and analyzed to evaluate whether either method is more safe regarding maternal and fetal outcomes. Results: There was a significant higher percentage of extension of uterine incision in group 1 (p = 0.002). Also, there were significant higher mean values of operative time and operative blood loss in group 1 (p = 0.008 and 0.015; respectively). On the other hand, there was a significantly shorter uterotomy to delivery time in group 1 (p < 0.001). There was a significantly higher mean value of APGAR score at one minute in group 1 (p = 0.043) but no significant difference between the two groups regarding APGAR score at five minutes, atonic PPH, postoperative blood transfusion and hospital stay. Conclusion: Vaginal push technique was associated with significantly higher intraoperative maternal morbidity but postoperative maternal morbidity and fetal outcomes were comparable between both groups. Push method (after uterine incision) is still the preferable method and larger studies are required to assess the fetal safety with reverse breech extraction.
宫颈完全扩张胎头阻生剖宫产术中子宫切开前反臀位抽出与阴道推入
目的:比较宫颈完全扩张、胎头撞击急诊剖宫产两种常用分娩方式的差异;阴道上推胎头和反向臀位提取的安全性和有效性。方法:回顾性观察研究152例宫颈完全扩张胎头阻生的急诊CS患者,分为两组;组1阴道推(n = 96),组2反臀位分娩(n = 56)。收集和分析数据变量,以评估是否两种方法对产妇和胎儿的结局更安全。结果:1组子宫切口延长率显著高于对照组(p = 0.002)。1组患者手术时间和术中出血量平均值显著高于对照组(p = 0.008、0.015;分别)。另一方面,1组剖宫产时间明显缩短(p <0.001)。第1组患者1分钟APGAR评分平均值显著高于第1组(p = 0.043),但两组患者5分钟APGAR评分、无张力PPH、术后输血及住院时间差异无统计学意义。结论:阴道推术术中产妇发病率显著增高,但两组术后产妇发病率和胎儿结局无明显差异。推法(子宫切开后)仍是较好的方法,需要更大规模的研究来评估反向臀位取出术的胎儿安全性。
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来源期刊
Journal of Clinical Obstetrics and Gynecology
Journal of Clinical Obstetrics and Gynecology Medicine-Obstetrics and Gynecology
CiteScore
0.30
自引率
0.00%
发文量
8
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