315 results match your criteria Labor and Delivery Breech Extraction


Committee Opinion No. 415: Impacted Fetal Head, Second-Stage Cesarean Delivery.

J Obstet Gynaecol Can 2021 03;43(3):406-413

Toronto, ON.

Objective: To review the most effective clinical approaches to disengage an impacted fetal head during cesarean delivery.

Target Population: Women who undergo cesarean delivery of an infant with a deeply impacted head.

Options: The "push" technique (from below) or the "pull" technique (reverse breech extraction). Read More

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Reverse Breech Extraction Vs Head Pushing For Delivery Of Deeply Impacted Fetal Head In Emergency Caesarean Section.

J Ayub Med Coll Abbottabad 2020 Oct-Dec;32(4):497-501

HOD Gynae/Obst. CMH Abbottabad, PAF Quetta, Pakistan.

Background: Obstructed labour is considered a negligible component of maternal mortality in developed countries but it is a major mortality burden in developing countries. This study was done to compare maternal outcome associated with reverse breech extraction and vaginal head pushing method for the deeply impacted foetal head in emergency caesarean section.

Methods: It was done at the Department of Obstetrics and Gynaecology Military Hospital, Rawalpindi from May to Nov 2014. Read More

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January 2021

Impacted foetal head at caesarean section: a national survey of practice and training.

J Obstet Gynaecol 2021 Apr 29;41(3):360-366. Epub 2020 Jul 29.

Women's Health Department, North Bristol NHS Trust, Bristol, UK.

This is a national survey of UK obstetric trainees and consultant labour ward leads designed to investigate the current practice and training for an impacted foetal head (IFH) at Caesarean Section (CS). An anonymous, on-line survey was disseminated to trainees via Postgraduate Schools and RCOG trainee representatives, and to labour ward leads via their national network. Three hundred and forty-five obstetric trainees and consultants responded. Read More

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Anesthesia efficacy of bupivacaine in pregnant participants with breech presentation receiving external cephalic version: A protocol of systematic review of randomized controlled trials.

Medicine (Baltimore) 2020 Jun;99(25):e20786

Department of Emergency, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.

Background: The objective of this study is to appraise the efficacy and safety of bupivacaine in pregnant participants with breech presentation (BP) receiving external cephalic version (ECV).

Methods: The following electronic databases will be searched from the origin to the January 31, 2020: PUBMED, EMBASE, Cochrane Library, CINAHL, ACMD, PsycINFO, Scopus, OpenGrey, and China National Knowledge Infrastructure. No language and publication time limitations will be applied to all of them. Read More

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Fetal extraction maneuvers during cesarean delivery in the second stage of labor.

J Matern Fetal Neonatal Med 2020 Jun 16:1-7. Epub 2020 Jun 16.

Rabin Medical Center, Helen Schneider Hospital for Women, Petach Tikva, Israel.

To compare maternal and neonatal outcomes following cesarean delivery during second stage of labor, according to the fetal extraction method.: A retrospective cohort study of all women who underwent term cesarean delivery during the second stage of labor at a university-affiliated tertiary medical center (2012-2016). The cohort was divided according to three extraction methods: standard vertex extraction, the push method in which the head extraction is accompanied by pushing through the vagina, and the reverse breech extraction method. Read More

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Simulation-based training of vaginal twin delivery for experienced gynaecologists: Useful or not?

Eur J Obstet Gynecol Reprod Biol 2020 Aug 25;251:89-97. Epub 2020 May 25.

Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.

Objective: It is important to train clinicians to maintain and optimise maternal and neonatal outcomes after vaginal twin delivery. Simulation-based training provides opportunities for training in a realistic way without harming patients. The aim of this study is to evaluate the effect of simulation-based training concerning twin vaginal delivery on knowledge and comfort of obstetrician-gynaecologists. Read More

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Internal Version Compared With Pushing for Delivery of Cephalic Second Twins.

Obstet Gynecol 2020 06;135(6):1435-1443

Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Université de Paris, INSERM, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Assistance Publique-Hôpitaux de Paris, Maternité Port-Royal, DHU risques et grossesse, Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint-Joseph, and Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Gynécologie Obstétrique, Paris, Université Paris Sud, Le Kremlin Bicêtre, CHRU de Lille, Maternité Jeanne de Flandre, and Université de Lille 2, Lille, Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Gynécologie Obstétrique, and Université Pierre et Marie Curie, Paris, Centre Hospitalier Intercommunal de Poissy, Service de Gynécologie Obstétrique, Poissy, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, CHU de Strasbourg, Hôpital Hautepierre, and Université de Strasbourg, Strasbourg, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Gynécologie Obstétrique, Le Kremlin Bicêtre, CHU de Bordeaux, Service de Gynécologie Obstétrique, and Université de Bordeaux, Bordeaux, CHU de Toulouse, Service de Gynécologie Obstétrique, and Université Toulouse III Paul Sabatier, Toulouse, and CHU de Nantes, Service de Gynécologie Obstétrique, CIC Mère enfant, INRA, UMR 1280 Physiologie des adaptations nutritionnelles, and Université de Nantes, Nantes, France.

Objective: To assess neonatal morbidity and mortality according to whether cephalic second twins were born after internal version followed by total breech extraction or after instructions to push. We hypothesized that interval version would result in shorter intertwin delivery intervals and lower cesarean delivery rates for the second twin and therefore better neonatal outcomes.

Methods: These planned analyses of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of twin deliveries, examined births of cephalic second twins after vaginal birth of the first twin at or after 32 weeks of gestation. Read More

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Cephalic extraction versus breech extraction in second-stage caesarean section: a retrospective study.

BJOG 2020 11 8;127(12):1568-1574. Epub 2020 Jun 8.

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.

Objective: Our primary objective was to compare maternal and neonatal outcomes based on the attempted mode of extraction. Our secondary objective was to compare the outcomes based on the actual mode of extraction.

Design: A retrospective cohort study at a single tertiary centre between the years 2011 and 2019. Read More

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November 2020

Reverse breech extraction at cesarean section in second stage of labor.

Wiad Lek 2020 ;73(5):1028-1031

Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.

Objective: The aim: Taking into consideration the increase in the frequency of urgent C-sections in the second stage of labor and significant technical difficulties in the extraction of deeply impacted fetal head during this operation, the aim of our work was to analyze the current published biomedical data to identify the optimal technical strategies for conducting this type of surgical interventions.

Patients And Methods: Materials and methods: The search and analysis of current clinical data available in PubMed was performed. We analyzed 9 retrospective and randomized prospective studies with collected data from a total of 974 women (2002-2019). Read More

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[BREECH PRESENTATION DELIVERY CARE: A REVIEW OF CHILDBIRTH SEMIOLOGY, MECHANISM AND CARE].

Rev Colomb Obstet Ginecol 2019 12;70(4):253-265

Residente de tercer año de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia.

Objective: To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome.

Methods: Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction.

Results: Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. Read More

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December 2019

Use of automated fetal heart rate analysis to identify risk factors for umbilical cord acidosis at birth.

Comput Biol Med 2019 12 31;115:103525. Epub 2019 Oct 31.

Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France.

Objective: To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition.

Methods: Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7. Read More

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December 2019

Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor.

J Obstet Gynaecol Res 2019 Dec 9;45(12):2386-2393. Epub 2019 Sep 9.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Aim: To compare maternal and neonatal outcomes between the 'head first' and 'legs first' delivery methods during a second stage cesarean section.

Methods: We conducted a retrospective study between January 2009 and May 2015 at a large public university tertiary referral center. Included were all women who underwent cesarean delivery with a fully dilated cervix and a fetal head at the level of the ischial spines or below. Read More

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December 2019

Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program.

J Perinat Med 2019 Oct;47(8):857-866

Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland.

Background Although cesarean sections at full dilatation are increasing, training in delivering a deeply impacted fetal head is lacking among obstetricians. The purpose of the study was to implement and evaluate a theoretical and simulation-based training program for this obstetrical emergency. Methods We developed a training program consisting of a theoretical introduction presenting a clinical algorithm, developed on the basis of the available literature, followed by a simulation session. Read More

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October 2019

Classic metaphyseal lesion of distal tibia following footling breech delivery.

Pediatr Radiol 2019 12 5;49(13):1840-1842. Epub 2019 Aug 5.

Center for the Protection of Children, Penn State Health Children's Hospital, Penn State College of Medicine, Hershey, PA, USA.

Classic metaphyseal lesions associated with childbirth are rare. We report a distal tibial metaphyseal fracture following a difficult breech delivery. Classic metaphyseal fractures are considered highly specific injuries associated with non-accidental trauma. Read More

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December 2019

Maternal and neonatal outcome of reverse breech extraction of an impacted fetal head during caesarean section in advanced stage of labour: a retrospective cohort study.

BMC Pregnancy Childbirth 2019 Mar 27;19(1):98. Epub 2019 Mar 27.

Division of Obstetrics, University Hospital Zurich, Zurich, Switzerland.

Background: Caesarean section with extraction of a deeply impacted fetal head is technically challenging and is associated with serious maternal and neonatal complications. The purpose of the study was to identify risks and evaluate selected outcome parameters associated with difficult fetal head extraction during caesarean section in advanced labour comparing two different extraction techniques (head pushing vs. reverse breech). Read More

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Comparison of 'push method' with 'Patwardhan's method' on maternal and perinatal outcomes in women undergoing caesarean section in second stage.

J Obstet Gynaecol 2019 Jul 27;39(5):606-611. Epub 2019 Mar 27.

a Department of Obstetrics and Gynecology , Jawaharlal Institute of Post-graduate Medical Education and Research , Puducherry , India.

A deeply impacted foetal head in a second stage caesarean section is associated with an increased risk of maternal and neonatal complications. For the present study, we compared the maternal and neonatal outcomes during the use of the 'Push method' and of 'Patwardhan's method' for a foetal head delivery in a second-stage caesarean section. This was a retrospective observational study involving 298 women who underwent a second stage caesarean section with a foetal head at or below the level of their ischial spines and was conducted in a tertiary teaching hospital in South India. Read More

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Twin vaginal delivery: To maintain skill - simulation is required.

Eur J Obstet Gynecol Reprod Biol 2019 Mar 24;234:195-199. Epub 2019 Jan 24.

Hôpital Bichat, Maternité Aline de Crepy, APHP, 75018, Paris, France; Université Paris Diderot, Paris 7, Paris, France; Ilumens Paris Diderot, Centre de simulation, Paris, France; DHU Risk and Pregnancy (Paris V and Paris VII University), France. Electronic address:

Background: Although most societies of obstetrics advocate vaginal delivery of twins, there has been a steady rise in the rate of twin cesarean sections. We risk perhaps losing in a single generation our obstetrical learning and skills because of medicolegal and emotionally charged issues.

Methods: We have therefore designed a realistic as possible simulation model of second twin delivery and tested it on residents in obstetrics. Read More

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Assessment of Current Epidemiology and Risk Factors Surrounding Brachial Plexus Birth Palsy.

J Hand Surg Am 2019 Jun 25;44(6):515.e1-515.e10. Epub 2018 Sep 25.

Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.

Purpose: Brachial plexus birth palsy (BPBP) is common; however, the current incidence is unknown and more than 50% of infants with BPBP have no known risk factors. The purpose of this study was to determine the current incidence of BPBP, assess known risk factors, and evaluate hypotonia as a new risk factor, as well as estimate the length of stay (LOS) and direct costs of children with an associated BPBP injury.

Methods: Data from the 1997 to 2012 Kids' Inpatient Database data sets were evaluated to identify patients with a BPBP injury and various risk factors. Read More

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Evaluation of a Quality Improvement Intervention to Increase Vaginal Birth for Twins.

Obstet Gynecol 2018 07;132(1):85-93

Division of Maternal-Fetal Medicine and the Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Objective: To evaluate whether there was an association between the systematic promotion of twin vaginal delivery and an increase in the rates of twin vaginal birth.

Methods: We conducted a retrospective cohort study. We implemented a quality improvement initiative promoting twin vaginal delivery at an academic tertiary care center in 2013. Read More

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Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study.

BMC Pregnancy Childbirth 2018 May 18;18(1):176. Epub 2018 May 18.

Department of Obstetrics and Gynecology (OB/GYN), Paracelsus Medical University, Muellner Hauptstr. 48, A-5020, Salzburg, Austria.

Background: Spontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic. Aim of this study is to identify obstetric factors influencing the condition of second twin and to verify whether non-cephalic presentation and vaginal breech delivery of the second twin is safe.

Methods: This is a retrospective case controlled cohort study of 717 uncomplicated twin deliveries ≥32 + 0 weeks of gestation from 2005 to 2014 in two tertiary perinatal centers. Read More

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A Simulator for Breech Extraction of the Second Twin.

Obstet Gynecol 2018 06;131(6):1057-1061

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, Pennsylvania.

Background: Breech extraction of a second twin is a skill useful for any health care provider planning on undertaking vaginal delivery of twins. However, training opportunities in this skill may be limited.

Method: Using readily available supplies, a reusable model neoprene uterus can be constructed, as can a balloon model to simulate a fetus in the amniotic cavity. Read More

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[E.G. Simon in reply to the article by L. Hejl et al.: Vaginal delivery in case of breech presentation: impact of a service's incentive. Gynecol Obstet Fertil Senol 2017;45(11):596-603].

Authors:
E G Simon

Gynecol Obstet Fertil Senol 2018 02 19;46(2):133-134. Epub 2018 Jan 19.

Pôle de gynécologie obstétrique, médecine fœtale, reproduction et génétique, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR Inserm U930, université de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France. Electronic address:

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February 2018

Internal Podalic Version and Breech Extraction: Enhancing Realistic Sensations in a Simulation Model.

Obstet Gynecol 2018 02;131(2):360-363

Departments of Obstetrics and Gynaecology, Pediatrics, and Epidemiology, Erasmus Medical Center, Rotterdam, and Managing Obstetrical Emergencies and Trauma (MOET), Stichting MOET, Tilburg, the Netherlands.

Background: Experience with internal podalic version and breech extraction is diminishing, especially in the younger generation of obstetricians. Simulation training is essential to teach and maintain these skills.

Instrument: We present a mannequin-based simulation method that enhances realistic sensations during training. Read More

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February 2018

Labor and Delivery of Twin Pregnancies.

Obstet Gynecol Clin North Am 2017 Dec;44(4):645-654

Maternal Fetal Medicine Associates, PLLC, and The Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 70 East 90th Street, New York, NY 10128, USA. Electronic address:

Obstetricians who care for twin pregnancies should be aware of the challenges that may arise during the labor and delivery. With recognition of these issues and proper training, providers should be able to help women with twin pregnancies achieve a safe delivery for them and their babies. With the use of breech extraction of the second twin and active management of the second stage of labor, women with twin pregnancies can also achieve a high vaginal delivery rate of both twins. Read More

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December 2017

Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia.

Afr Health Sci 2017 Mar;17(1):1-6

Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Ethiopia.

Back Ground: New born babies with low Apgar scores are at an increased risk of perinatal morbidity and mortality.

Objective: To assess proportion and factors associated with low 5 minute Apgar Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia.

Methods: A cross-sectional study was conducted on singleton 261 live births from March - May, 2013. Read More

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Vaginal breech delivery at term and neonatal morbidity and mortality - a population-based cohort study in Sweden.

J Matern Fetal Neonatal Med 2019 Jan 22;32(2):265-270. Epub 2017 Sep 22.

c Karolinska University Hospital , Stockholm , Sweden.

Introduction: The routine to deliver almost all term breech cases by elective cesarean section (CS) has continued to be debated due to the risk of maternal and neonatal complications. The aims of the study were (1) to investigate if mode of delivery impacts on the risk of morbidity and mortality among term infants in breech presentation and (2) to compare the rates of severe neonatal complications and mortality in relation to presentation and mode of delivery.

Methods: This population-based cohort study used data from the Swedish Medical Birth Register. Read More

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January 2019

Twin vaginal delivery: innovate or abdicate.

Am J Obstet Gynecol 2017 05 7;216(5):484-488.e4. Epub 2017 Feb 7.

Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. Read More

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Reverse breech extraction versus the standard approach of pushing the impacted fetal head up through the vagina in caesarean section for obstructed labour: A randomised controlled trial.

J Obstet Gynaecol 2017 May 31;37(4):459-463. Epub 2017 Jan 31.

c Obstetrics and Gynaecology Department , Al-Ahrar District General Hospital , Zagazig , Egypt.

The objective of this study was to assess effectiveness and safety of the reverse breech extraction approach in Caesarean section for obstructed labour, and compare it with the standard approach of pushing the fetal head up through the vagina. This randomised controlled trial included 192 women. In 96, the baby was delivered by the 'reverse breech extraction approach', and in the remaining 96, by the 'standard approach'. Read More

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Locked twins: successful vaginal delivery of both twins after Zavanelli manoeuvre of Twin B.

Eur J Obstet Gynecol Reprod Biol 2016 Dec 28;207:236-237. Epub 2016 Oct 28.

Université de Lille, Faculté de Médecine, Lille, France; Service de gynécologie-obstétrique, CHU Lille, Lille, France.

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December 2016

Techniques for assisting difficult delivery at caesarean section.

Cochrane Database Syst Rev 2016 Jan 31(1):CD004944. Epub 2016 Jan 31.

Women's and Children's Division, Lyell McEwin Hospital, Haydown Road, Elizabeth, SA, Australia.

Background: Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant or complications for the mother. Read More

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January 2016