2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.
J Perinat Med. 2022 Feb 7;50(4):446-456. doi: 10.1515/jpm-2021-0572. Print 2022 May 25.
Late first-stage or second-stage cesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-analysis was to compare maternal and neonatal outcomes associated with delivery techniques via cesarean section.
An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomised comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during cesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses.
Nineteen articles, including 2,345 women were analyzed. Three fetal extraction techniques were identified. Meta-analyses showed that the "pull" technique carries lower risks as compared to the "push" technique and the "Patwardhan" technique is safer compared to the "push" or the "push and pull" technique.
In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the "pull", as well as the "Patwardhan" technique represent safe options to deliver an impacted fetal head.
晚期第一产程或第二产程剖宫产常伴有胎头嵌顿，导致母婴并发症。这种情况需要安全的分娩技术，但最佳处理方法仍存在争议。本荟萃分析的目的是比较剖宫产时通过不同分娩技术的母婴结局。
从建库至 2021 年 6 月，对三个数据库进行电子检索。纳入与剖宫产时用于娩出胎头嵌顿的技术相关的母婴结局的队列和随机对照研究。对初级研究的方法学质量进行评估。使用 Review Manager 5.4 进行统计分析。
分析了 19 篇文章，包括 2345 名妇女。确定了三种胎儿取出技术。荟萃分析表明，与“推”技术相比，“拉”技术的风险较低，与“推”或“推和拉”技术相比，“Patwardhan”技术更安全。
在缺乏支持特定技术使用的有力证据的情况下，产科医生的选择应基于现有最佳证据。我们的研究表明，“拉”以及“Patwardhan”技术是娩出胎头嵌顿的安全选择。
