European Journal of Biomedical and Pharmaceutical Sciences

COMPARISON OF BREECH EXTRACTION VS. HEAD PUSH TECHNIQUES FOR DEEPLY IMPACTED FETAL HEADS IN SECOND-STAGE CESAREAN SECTIONS: A RETROSPECTIVE STUDY

Alaaldin Ahmed Hindawi*, Rami Suleiman Alrbeihat, Ahmad Bassam Zureigat, Ammar Abd Alaziz Almaaitah, Laith Yasin Ali Qatarneh, Rana Abbas Hazeem, Farah Bilal Salman and Dana Issa Juma Ibrahim

ABSTRACT

Background: Delivering deeply impacted fetal heads during second-stage cesarean sections poses substantial risks, including uterine trauma and maternal hemorrhage. Two common techniques, reverse breech extraction and head push, lack robust comparative data to guide clinical decision-making. Purpose: This study aims to compare maternal outcomes of reverse breech extraction versus head push techniques to inform best practices for second-stage cesarean sections. Methods: A retrospective cohort study was conducted at Queen Alia Military Hospital over 22 months, involving 105 term singleton pregnancies in cephalic presentation. Data on maternal characteristics, surgical details, and postoperative outcomes were analyzed. Mann-Whitney U, Chi-square, and linear regression analyses were performed to compare outcomes between the techniques. Results: Reverse breech extraction was performed in 57% of cases and head push in 43%. Uterine incision extensions were significantly lower with reverse breech extraction (15%) compared to head push (49%, p < 0.001). Delivery times were shorter for head push (median: 41 minutes) than reverse breech extraction (median: 59 minutes, p < 0.001). Postoperative fever and blood transfusion rates did not significantly differ between techniques. Conclusion: Reverse breech extraction, while associated with longer operative times, resulted in fewer uterine incision extensions, suggesting it may be a safer option for deeply impacted fetal heads. Further prospective studies are needed to confirm these findings and optimize delivery strategies.

Keywords: Cesarean section, reverse breech extraction, head push technique, deeply impacted Fetal head, maternal outcomes.