Comparison of "push" and "pull" methods for impacted fetal head extraction during cesarean delivery

Objective To compare maternal and neonatal outcomes associated with the “push” and “pull” methods for impacted fetal head extraction during cesarean delivery. Methods A prospective study was conducted at Imam Reza Hospital, Kermanshah, Iran, from April 2006 to March 2008. After failed vacuum extraction, women with obstructed labor caused by impacted fetal head were randomly assigned to deliver via the push method (n = 35) or the pull method (n = 37). The outcomes investigated included operation time, operative blood loss, incidence of extension of the uterine incision, and postpartum fever. Data were analyzed using χ2 and Student t tests. Results Mean operative time and incidence of extension of the uterine incision were significantly increased in the group that delivered via the push method (P < 0.001). There were no significant differences in the other maternal and neonatal morbidities between the groups, although there was 1 case of neonatal femoral fracture in the pull group. Conclusion Although the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than the push method when used for impacted fetal head extraction during cesarean delivery.