Critical Care Obstetrics and Gynecology

Cesarean Section of an Impacted Fetal Head at Full Cervical Dilatation â?? Evaluation of Patwardhan Technique

Background- Delivery of a deeply impacted fetal head in second stage cesarean is associated with adverse fetal and maternal outcomes.
Objective- To compare maternal and neonatal morbidities by Patwardhan technique and Hand-Push method for delivery of the impacted fetal head during cesarean section at full cervical dilatation.
Methodology- Retrospective cohort study which included 100 women admitted to J.J.M Medical College, Davangere with single fetus at term in vertex position with head deeply impacted in the pelvis that underwent second stage caesarean section with fetal head at or below the level of ishchial spine from October 2018 to September 2019. In the first group all cases were extracted by Patwardhan and in the second group extraction of fetus was done by Hand-Push method.
Results- Extension of uterine incision was seen in 2% of patients in Patwardhan group as compared to 16% in Push Method. Traumatic PPH, uterine artery laceration, need for blood transfusion and hysterectomy were more in Push method. NICU admissions were comparable in both the groups. APGAR score comparison between the two methods of extraction at 1min (p=0.015) and at 5min (p=0.01) indicated that Patwardhan group showed considerable advantage over the Push method.
Conclusion- The Patwardhan technique is safer and better than the Push method during delivery of a deeply engaged fetal head in cesarean section at full cervical dilatation.

Riya Bhattacharya*, A.C. Ramesh1