Abstract

Objective: To compare effectiveness of push and pull methods of delivery used to extract the impacted fetal head during cesarean delivery for prolong second stage of labor in terms of preventing uterine incision extension.
Methodology: This randomized controlled trial was done in obstetrics & gynecology department of Benazir Bhutto Hospital (BBH), Rawalpindi from December 2018 to June 2019. A total of 86 consecutive patients of prolonged second stage of labor with deeply impacted fetal head were included in the study. Patients were allocated in two groups; pull method (Group A) and push method (Group B). All patients underwent cesarean section. A deeply impacted fetal head was delivered either by pull method or push method. Extension of uterine incision or tear/laceration more than 2cm in lower uterine segment was assessed subjectively by surgeon as presence or absence of tear from normal uterine incision.
Results: The study had 86 patients with mean age of 28.32±3.6 years. The ‘push’ method was associated with extension of the uterine incision (19 [79.0%] vs 5 [21.0%]) (p=0.001) compared to ‘pull’ method.
Conclusion: Pull technique had considerably lower risk of extension of the uterine incision as compared to push technique.

Key words: Push and pull method, cesarean section, second stage labor, uterine incision.