External Pop-out and Classic Fetal Head Extract During Cesarean Section
Condition: Cesarean Section Complications
Study type: Interventional

Summary: 
      Cesarean section is the delivery of the fetus through a surgical incision in the abdominal
      wall (laparotomy) and uterine wall (hysterotomy). The rate of cesarean delivery has increased
      progressively in the last decades until it becomes the most common operation performed all
      over the world.

      A multitude of efforts had been done aiming at a reduction of cesarean section related
      maternal morbidities; most of them are related to technical modifications of how to open and
      how to close the abdominal and uterine incisions. The comparative studies of blunt versus
      sharp extension of the uterine incision showed a reduction of the incidence of unintended
      extension from 8.8% to 4.8%.

      Delivery of the fetal head through the uterine incision is one of the major technical
      problems during elective cesarean section, especially when the presenting part is
      non-engaged. All of the previously described procedures, alternative to the classic manual
      head extraction, were inconclusive and not convincing to the obstetricians for routine use.

      Also, no reported well-designed trials favor one of them over other. Application of vacuum
      cup, use of forceps blade, increasing fundal pressure and making additional uterine incisions
      were previously reported as alternative techniques. None of them gain any popularity or
      proved to be used as a basic step during cesarean section, besides many complications were
      reported due to their use on mothers and infants.

      The vulnerability of the lower uterine segment for tears is related to the stage of labor.
      The frequency of unintended extension was reported to be 15.5%, and 35.0% in cases operated
      in first and second stages of labor respectively.

      As with any surgical operation, anticipating difficulties during cesarean delivery and
      avoiding these difficulties is always the greatest practice. Although much has been written
      about techniques for managing difficult head extraction during vaginal deliveries, the
      reports addressed the management of difficult head delivery during cesarean section in
      literature are scarce.

      The original techniques of fetal head extraction entail the introduction of the obstetricians
      hand or other instruments into the lower uterine segment. This puts the lower uterine segment
      at risk of damage and incision extensions with its consequences of increased blood loss,
      increased operative time, infection, adhesion and blood transfusion. Adherence to the
      available the generated good quality evidence bases practice in cesarean section is
      anticipated to decrease such morbidities.

      The idea of the present technique was derived from the fact that during vaginal delivery the
      main task of the obstetrician is to support the perineum while the fetal head extends to get
      out through birth canal.
    


Intervention name(s): Classic head extraction during Cesarean section; External pop out technique
Intervention type(s): Procedure; Procedure
Intervention description(s): by putting the fingers of the right inside the lower uterine segment to deliver the head; The palmar aspect of the fingers will be resting on the uterovesical peritoneal reflection not directly on the fetal head.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention