Push With Lower Uterine Segment Support
- Conditions
- Dystocia
- Interventions
- Procedure: Cesarean section
- Registration Number
- NCT02934516
- Lead Sponsor
- Assiut University
- Brief Summary
The study aims to compare maternal and early neonatal outcomes of abdominal disimpaction with lower uterine segment support in comparison to the classic "push" method for delivery of impacted fetal head during Cesarean section for obstructed labor.
- Detailed Description
Obstructed labor refers to failure of labor progress in spite of good uterine contractions and is attributed to mismatch between the size of the presenting part of the fetus and the mother's pelvis. Approximately 8% of maternal deaths worldwide are attributed to obstructed labor and subsequent puerperal infection, uterine rupture, and postpartum hemorrhage.
In these situations, Cesarean section could minimize maternal and neonatal morbidity. However, Cesarean section is challenging when the head is deeply impacted and is associated with high risk of maternal injuries and perinatal injuries. The most common complication is extension of uterine incision which could involve the vagina, bladder, ureters and broad ligament. Neonates are also at risk of skull fractures, cephalhematoma, and subgaleal hematoma mainly due to manipulations. Currently, the most popular approaches for fetal head delivery are the push and pull methods. Although push method seems to be more convenient and does not necessitate extensive experience, it is more significantly associated with extension than the pull method. Although pull method seems to be more safe, it is more difficult to perform and usually warrants an aggressive uterine incision to deliver the fetus. In 2013, investigators published a case series on abdominal disimpaction with lower uterine segment support which basically allows obstetricians to deliver the fetal head through a transverse uterine incision with minimal risk of extensions and neonatal complications. In this study, investigators aim to validate this approach in comparison to the classic push method.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- Female
- Target Recruitment
- 66
- Singleton term pregnancy, 37 to 42 weeks of gestation.
- Cephalic presentation.
- The cervix is fully dilated.
- Ruptured membranes.
- Adequate uterine contractions.
- Impacted fetal head in maternal pelvis
- Intrauterine fetal death
- Major fetal anomalies
- Non-cephalic presentation
- Multiple pregnancy
- Preterm caesarean < 37 weeks
- Abnormal placentation.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Disimpaction with lower uterine support Cesarean section Cesarean section with support of the lower uterine segment Classic push method Cesarean section Cesarean section with push method
- Primary Outcome Measures
Name Time Method Extension of uterine incision During delivery of the fetus The incidence of extension of uterine incision
Length of extension of uterine incision During delivery of the fetus If extension of uterine incision happens, the length of extension will be measured
Injury of the vagina During delivery of the fetus Extension of uterine incision into the vagina
Injury of the bladder During delivery of the fetus Extension of uterine incision into the bladder
Injury of the ureter During delivery of the fetus Extension of uterine incision into the ureter
- Secondary Outcome Measures
Name Time Method APGAR score At 1 and 5 minutes after delivery of the newborn Cesarean section operative time Time from incision to closure of the skin (within 24 hours of recruitment) Duration of Cesarean section operation
Intra-operative blood loss During Cesarean section only Amount of blood loss as estimated by suction device from incision to closure of the skin
The incidence of postpartum hemorrhage During the first 24 hours post-operative Loss of more than 500 ml during the first 24 hours after surgery and the management that will be done
Incidence of blood transfusion During surgery and within the first 24 hours postoperative The incidence of blood transfusion due to significant blood loss (based on blood loss and clinical judgement "hypotension, tachycardia, pallor")
Fetal traumatic birth injuries During Cesarean section (fetal delivery) Skull fractures, limb fractures, brachial plexus injury, cephalhematoma, and subgaleal hematoma
Need for neonatal admission to neonatal intensive care unit Within 24 hours of delivery of the newborn Postoperative infections 1 week of postpartum Puerperal sepsis and Cesarean section wound infection