Comparison of maternal and neonatal complications of fetal delivery by cesarean section in three methods: cephalic, breech and anterior shoulder in deeply engaged fetal head

Document Type : Original Article

Authors

1 Professor, Department of Obstetrics and Gynecology, Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant Professor, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Caesarean section in deeply engaged fetal head is done by cephalic or breech method and these two methods are associated with maternal and neonatal complications. The present study was performed with aim to compare the maternal and neonatal complications of cesarean section in anterior shoulder method, cephalic and breech methods.
Methods: This clinical trial study was carried out in 2020-2021 on 111 mothers referred for delivery in Omolbanin hospital of Mashhad. They had inclusion criteria and consent to participate in the study. Cesarean section was performed in three groups of 37 people: cephalic, breech and anterior shoulder method. The duration of surgery, amount of bleeding, extension of incision, bladder trauma, uterine vessels trauma, Apgar score, newborn's trauma, need to NICU admission, and duration of mother and newborn hospitalization were compared in three groups. Data were analyzed by SPSS software (version 25) and ANOVA, Kruskal-Wallis and chi-square tests. P<0.05 was considered statistically significant.
Results: Among maternal complications, extension of uterine incision (p=0.008) and trauma to uterine vessels (P=0.033) was less in the anterior shoulder group than the other two groups and the difference was significant. There was no significant difference between the three groups in neonatal complications, only pH of the umbilical cord blood of the newborns was significantly different between the three groups (p=0.035). Based on the results of Mann-Whitney post hoc test, the cord blood pH of infants in the anterior shoulder group was significantly higher than the cephalic (p=0.023) and breech (p=0.037) groups.
Conclusion: Cesarean section in deeply engaged fetal head with the anterior shoulder method had less maternal complication include extension of uterine incision and trauma to the uterine vessels. In this study, there was no significant difference between the three groups in neonatal complications, and only the neonatal cord blood pH in the anterior shoulder group was better than the other two groups, so it is safe to choose the anterior shoulder method in this type of cesarean section.

Keywords


  1. Chopra S. Disengagement of the Deeply Engaged Fetal Head during Cesarean Section Conventional Method versus Reverse Breech Extraction-Review of Literature. Clin Mother Child Health 2016; 13(2):1000239.
  2. Visconti F, Quaresima P, Rania E, Palumbo AR, Micieli M, Zullo F, et al. Difficult caesarean section: A literature review. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 246:72-8.
  3. Chopra S, Bagga R, Keepanasseril A, Jain V, Kalra J, Suri V. Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: conventional method versus reverse breech extraction. Acta obstetricia et gynecologica Scandinavica 2009; 88(10):1163-6.
  4. Manning JB, Tolcher MC, Chandraharan E, Rose CH. Delivery of an impacted fetal head during cesarean: a literature review and proposed management algorithm. Obstetrical & Gynecological Survey 2015; 70(11):719-24.
  5. Schwake D, Petchenkin L, Younis JS. Reverse breech extraction in cases of second stage caesarean section. Journal of Obstetrics and Gynaecology 2012; 32(6):548-51.
  6. Patwardhan BD, Motashaw ND. Caesarean section. J Obstet Gynecol India 1957; 8:1-5.
  7. Dalvi SA. Difficult deliveries in cesarean section. the Journal of Obstetrics and Gynecology of India 2018; 68(5):344-8.
  8. Veisi F, Zangeneh M, Malekkhosravi S, Rezavand N. Comparison of “push” and “pull” methods for impacted fetal head extraction during cesarean delivery. International Journal of Gynecology & Obstetrics 2012; 118(1):4-6.
  9. Dehvari A, Rashidi Fakar FI, Afshar F, Farzaneh F. Comparison of maternal and neonatal complications in caesarian section due to arrest of descent in pull VS push methods. Iran J Obstet Gynecol Infertil 2019; 21(12):11-5.
  10. Keepanasseril A, Shaik N, Kubera NS, Adhisivam B, Maurya DK. Comparison of ‘push method’with ‘Patwardhan’s method’on maternal and perinatal outcomes in women undergoing caesarean section in second stage. Journal of Obstetrics and Gynaecology 2019; 39(5):606-11.
  11. Saha PK, Gulati R, Goel P, Tandon R, Huria A. Second stage caesarean section: evaluation of patwardhan technique. Journal of Clinical and Diagnostic Research: JCDR 2014; 8(1):93-5.
  12. 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‚Äźanalysis. BJOG: An International Journal of Obstetrics & Gynaecology 2016; 123(3):337-45.
  13. Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay ZJ. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. European Journal of Obstetrics & Gynecology and Reproductive Biology 2005; 121(1):24-6.
  14. Krispin E, Fischer O, Kneller M, Arbib N, Salman L, Wiznitzer A, et al. Fetal extraction maneuvers during cesarean delivery in the second stage of labor. The Journal of Maternal-Fetal & Neonatal Medicine 2022; 35(11):2070-6.
  15. Gil M, Chill HH, Kogan L, Porat S, Levitt L, Eliasi E, et al. Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor. Journal of Obstetrics and Gynaecology Research 2019; 45(12):2386-93.