External Pop-Out Technique Versus Classic Head Extraction During Cesarean Section

Study Overview
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Brief Summary
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Caesarean section is one the most common operations worldwide, its rates are globally increasing. A multitude of efforts had been done aiming at reduction of Caesarean 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% . The vulnerability of the lower uterine segment for tears are related to 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. 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 adhesions and blood transfusion. Adherence to the available the generated good quality evidence bases practice in Caesarean section is anticipated to decease such morbidities. The idea of the present technique was derived from the fact that during vaginal delivery the main task of obstetrician is to support the perineum while the fetal head extends to get out through birth canal.

Official Title
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Feasibility and Outcomes of External Pop-out Versus Classic Fetal Head Extract During Cesarean Section

Conditions
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Caesarean Section

Intervention / Treatment
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* Procedure: External Pop-Out Cesarean Section
* Procedure: Classic technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: single fetus more than 37 weeks of gestation elective Caesarean section Exclusion Criteria: non-cephalic presentation placenta previa hydrocephalus Multiple pregnancy

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: External Pop-Out Cesarean Section<br> | Procedure: External Pop-Out Cesarean Section<br>* During fetal head extraction, the obstetrician puts four fingers of his right hand on the lower segment at uterovesical pouch. The palmar aspect of the fingers will be resting on the uterovesical peritoneal reflection not on directly on the fetal head. While the palmar aspect of the fingers was facing the lower segment they were pushed deep below the fetal head.<br>|
| Other: Classic technique<br> | Procedure: Classic technique<br>* During fetal head extraction, the obstetrician puts four fingers of his right hand inside the uterus.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The success rate of External POP out technique |  | 20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of women will need blood transfusion |  | 24 hours | 
| Time of head extraction |  | 5 minutes | 
| Easiness score: | The ES was calculated at a graduated Likert-type scale from zero to 100; in which zero means terribly difficult and 100 means very easy. | 5 minutes |