Abdominal Disimpaction with Lower Uterine Segment Support as a Novel Technique to Minimize Fetal and Maternal Morbidities during Cesarean Section for Obstructed Labor: A Case Series

Abstract

Cesarean section for obstructed labor remains a difficult procedure that may be associated with serious fetal and maternal injuries. In this case series, we evaluated the use of abdominal disimpaction with lower segment support as a novel technique to minimize morbidities. Eight patients who underwent cesarean section for obstructed labor were recruited. Impacted fetal head was delivered using this technique and uterine extensions, bladder injury, vaginal injury, and intraoperative bleeding were reported. Maternal and neonatal outcomes were observed postoperatively. No major morbidities were reported. Accordingly, we consider this technique as a promising step to minimize complications during cesarean section for obstructed labor.

Keywords

obstructed labor - impacted head - abdominal disimpaction with lower uterine segment support - Shazly's step

Note

The study was conducted in the Woman's Health Center, Assiut University Hospital.

• References

• 1 World Health Organization. Maternal Mortality. World Health Day—Safe Motherhood. Geneva, Switzerland: WHO; 1998. (2): 1-3
• 2 Mahler H. The safe motherhood initiative: a call to action. Lancet 1987; 1: 668-670
• 3 World Health Organization. Maternal Mortality Ratios and Rates—A Tabulation of Available Information. 3rd ed. Geneva, Switzerland: WHO; 1991
• 4 Pattinson RC, Moodley J. Confidential enquiry into maternal deaths in South Africa. In: MacLean AB, Neilson JP, , eds. Maternal Morbidity and Mortality. London, UK: RCOG Press; 2002: 34-54
• 5 The American College of Obstetricians and Gynecologists (ACOG) authors. Operative Vaginal Delivery. Washington, DC: ACOG; 1994. (Technical Bulletin No. 196)
• 6 Rodriguez AI, Porter KB, O'Brien WF. Blunt versus sharp expansion of the uterine incision in low-segment transverse cesarean section. Am J Obstet Gynecol 1994; 171: 1022-1025
• 7 Landesman R, Graber EA. Abdominovaginal delivery: modification of the cesarean section operation to facilitate delivery of the impacted head. Am J Obstet Gynecol 1984; 148: 707-710
• 8 Fong YF, Arulkumaran S. Breech extraction—an alternative method of delivering a deeply engaged head at cesarean section. Int J Gynaecol Obstet 1997; 56: 183-184
• 9 Fasubaa OB, Ezechi OC, Orji EO , et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods. J Obstet Gynaecol 2002; 22: 375-378
• 10 Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay ZJ. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. Eur J Obstet Gynecol Reprod Biol 2005; 121: 24-26
• 11 Chopra S, Bagga R, Keepanasseril A, Jain V, Kalra J, Suri V. Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: conventional method versus reverse breech extraction. Acta Obstet Gynecol Scand 2009; 88: 1163-1166
• 12 Veisi F, Zangeneh M, Malekkhosravi S, Rezavand N. Comparison of “push” and “pull” methods for impacted fetal head extraction during cesarean delivery. Int J Gynaecol Obstet 2012; 118: 4-6