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

BackgroundSecond-stage caesarean section with a deeply impacted fetal head is associated with maternal and neonatal complications. ObjectivesSystematic review and meta-analysis to identify, appraise and synthesise 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. Search strategyOnline searches of MEDLINE (1946-January2015), EMBASE (1950-January2015), Web of Sciences (1950-2015), and the Cochrane Library databases were performed using a set of relevant keywords. Selection criteriaAll studies that compared the outcome of various techniques of delivering the baby's head at full-dilation caesarean section. Data collection and analysisMethodological quality was assessed using the Newcastle-Ottawa scale. Data collected from each of the studies included variables on the participants, comparisons used, and feto-maternal outcomes. Meta-analysis was performed using review manager5.3. Main resultsIn 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. Authors' conclusionsEvidence gathered from observational studies suggests that reverse breech extraction is associated with significantly lower maternal risks compared with the push method. Tweetable abstractMeta-analysis suggests reverse breech extraction during caesarean section to deliver impacted fetus is safer. Tweetable abstract Meta-analysis suggests reverse breech extraction during caesarean section to deliver impacted fetus is safer.