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), Rawalpindifrom
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.
Keywords: Cesarean section, second stage labor,
uterine, incision.
