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Fetal extraction at cesarean delivery

INTRODUCTION

As with any surgical procedure, anticipating potential difficulties during cesarean delivery and preventing these difficulties or having a plan for management is always the best practice. Although much has been written about techniques for managing difficult vaginal deliveries, there is a paucity of literature to assist obstetricians with a difficult cesarean delivery. The only information available is from case reports, small case series, and expert opinion.

Difficult fetal extraction occurs in 1 to 2 percent of cesarean deliveries [1]. Causes include:

Impacted fetal head

Floating fetal head

Extremely low birth weight infant

             

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Literature review current through: Jun 2014. | This topic last updated: Feb 3, 2014.
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References
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  1. Levy R, Chernomoretz T, Appelman Z, et al. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. Eur J Obstet Gynecol Reprod Biol 2005; 121:24.
  2. Sung JF, Daniels KI, Brodzinsky L, et al. Cesarean delivery outcomes after a prolonged second stage of labor. Am J Obstet Gynecol 2007; 197:306.e1.
  3. Landesman R, Graber EA. Abdominovaginal delivery: modification of the cesarean section operation to facilitate delivery of the impacted head. Am J Obstet Gynecol 1984; 148:707.
  4. Karasahin KE, Ercan M, Alanbay I, Baser I. Comment on 'Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: conventional method versus reverse breech extraction'. Acta Obstet Gynecol Scand 2010; 89:849.
  5. Lippert TH. Abdominovaginal delivery in case of impacted head in cesarean section operation. Am J Obstet Gynecol 1985; 151:703.
  6. Lippert TH. Bimanual delivery of the fetal head at cesarean section with the fetal head in midcavity. Arch Gynecol 1983; 234:59.
  7. Fasubaa OB, Ezechi OC, Orji EO, et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods. J Obstet Gynaecol 2002; 22:375.
  8. Tan EK. Difficult caesarean delivery of an impacted head and neonatal skull fracture: can the morbidity be avoided? J Obstet Gynaecol 2007; 27:427.
  9. Fong YF, Arulkumaran S. Breech extraction--an alternative method of delivering a deeply engaged head at cesarean section. Int J Gynaecol Obstet 1997; 56:183.
  10. Blickstein I. Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia. J Perinat Med 2004; 32:465.
  11. Berhan Y, Berhan A. A meta-analysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery. Int J Gynaecol Obstet 2014; 124:99.
  12. Mukhopadhyay P, Naskar T, Dalui R. Evaluation of Patwardhan’s technic - a four year study in a rural teaching hospital. J Obstet Gynecol India 2005; 55:244.
  13. Chopra S, Bagga R, Keepanasseril A, et al. Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: conventional method versus reverse breech extraction. Acta Obstet Gynecol Scand 2009; 88:1163.
  14. Khosla AH, Dahiya K, Sangwan K. Cesarean section in a wedged head. Indian J Med Sci 2003; 57:187.
  15. Apuzzio JJ, Salamon C. Cesarean section. In: Operative obstetrics, 3rd ed, Apuzzio JJ, Vintzileos AM, Iffy L (Eds), Francis & Taylor Books, Co, London 2006. p.356.
  16. Pelosi MA, Apuzzio J. Use of the soft, silicone obstetric vacuum cup for delivery of the fetal head at cesarean section. J Reprod Med 1984; 29:289.
  17. Clark SL, Vines VL, Belfort MA. Fetal injury associated with routine vacuum use during cesarean delivery. Am J Obstet Gynecol 2008; 198:e4.
  18. Fareeduddin R, Schifrin BS. Subgaleal hemorrhage after the use of a vacuum extractor during elective cesarean delivery: a case report. J Reprod Med 2008; 53:809.
  19. Arad I, Linder N, Bercovici B. Vacuum extraction at cesarean section--neonatal outcome. J Perinat Med 1986; 14:137.
  20. Obican SG, Brunner M, Larsen JW. Barton's forceps: An effective aid in cesarean deliveries. Contemporary OBGYN 2011. http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Bartons-forceps-An-effective-aid-in-cesarean-deliv/ArticleStandard/Article/detail/738940 (Accessed on September 21, 2011).