Disengagement of the deeply engaged fetal head during caesarean section in advanced labor: patwardhan versus push extraction

Background: To compare the maternal and neonatal morbidities between the “Patwardhan” technique and the “Push” method for extraction of the foetus in second stage caesarean sections.Methods: Retrospective cohort study was done at PESIMSR, Kuppam, AP from MAY 2012 to APRIL 2015. Women with single fetus at term in anterior vertex position, with the head deeply impacted in pelvis and needing cesarean delivery where included in the study. Group 1 consists of all cases in which extraction of fetus was done by Patwardhan technique and Group 2, in whom extraction of fetus was done by push method and extracted as vertex. Objective of the study was to assess selective complications like extension of the incision, injury to the surrounding structures, excessive bleeding, need for blood transfusion and the fetal outcome between the two groups.Results: Out of 98 cases reviewed, 46 belonged to group A (Patwardhan) and 52 belonged to group B (push). Patients in the push group had statistically significant higher rates of maternal morbidity in terms of uterine extension and other related complications. However; there were no differences in neonatal outcomes in both the groups.Conclusions: While complications are inherent in both methods, Patwardhan method of delivery of the fetus for second stage labour has been shown to confer considerable advantage in prevention of maternal morbidity over the push method in our institution. Our findings support the fact that the Patwardhan method could be a useful maneuver in intraoperative disengagement of fetal head, when encountered at second stage CS and it is our opinion that the Patwardhan manoeuvre can be practiced selectively as a primary technique.