Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis

A systemic review and meta-analysis was published in February issue of BJOG by Jeve YB et al to identify, appraise and synthesize existing evidence that evaluated various techniques of delivering a baby with a deeply impacted head at full-dilation caesarean section.

The primary outcome was uterine extension and secondary outcomes were other maternal and neonatal morbidities.

Online searches of MEDLINE, EMBASE, Web of Sciences, and the Cochrane Library databases were performed using a set of relevant keywords. All studies that compared the different methods of delivering the babies head at full dilatation caesarean section were included.

In total, 12 studies were included. Six studies (n = 455) examined primary outcomes.

Meta-analysis showed that the risks of uterine incision extension, infection, mean blood loss, and operative time were significantly higher with the push technique compared with the reverse breech extraction. The evidence to support the Patwardhan method and fetal pillow was inadequate.

Evidence gathered from observational studies suggests that reverse breech extraction is associated with significantly lower maternal risks compared with the push method.

Reference:

Jeve YB, Navti OB, Konje JC. Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis. BJOG 2016;123:337–345.