COMPARISON OF MATERNAL OUTCOMES BETWEEN PULL BREECH OUT VERSUS PUSH IMPACTED HEAD UP FOR DELIVERY OF DEEPLY IMPACTED FETAL HEAD AT FULL DILATION IN EMERGENCY CESAREAN SECTION

Abstract

Background

The Push method is widely practiced for delivering a deeply impacted fetal head during cesarean section but is often associated with serious maternal complications. The Pull (reverse breech extraction) method has been proposed as a safer alternative, yet it remains underutilized and lacks strong evidence in clinical guidelines, especially in low-resource settings.

Objective

This study aimed to compare maternal outcomes between the Pull and Push methods.

Material and Methods

A randomized controlled trial was carried out over six months in the Department of Obstetrics and Gynecology at Liaquat University of Medical and Health Sciences, Jamshoro. A total of 98 women underwent emergency cesarean section at full dilatation for a deeply impacted fetal head were enrolled and randomly assigned to Pull (n = 49) or Push (n = 49) groups. Baseline data included maternal age, gestational age, parity, residential status, and anesthesia type. Outcomes assessed were uterine incision extension, intraoperative blood loss, need for transfusion, operative duration, and hospital stay. All participants received standardized perioperative care, and statistical analysis compared outcomes both overall and across subgroups.

Results

The Pull method showed significant advantages, with lower rates of uterine incision extension, less blood loss, shorter operative time, and fewer transfusion requirements. Length of hospital stay did not differ between groups. The protective effect of Pull was particularly notable in older women, those with higher gestational age, and under spinal anesthesia.

Conclusion

Compared with Push, the Pull method provides safer and more efficient maternal outcomes in cases of deeply impacted fetal head. Its simplicity, effectiveness, and low cost make it a valuable option for improving maternal safety, especially in resource-constrained settings