ABSTRACT
Background: Caesarean section at full dilatation with deeply engaged head in the pelvis can be associated with increased maternal and perinatal morbidity .The objective of present study is to compare the maternal and perinatal morbidity between the Patwardhan′s technique and the routine “push” and “pull” method for extraction of the fetus in second stage caesarean. Method: It is retrospective study including 100 cases of caesarean section performed for obstructed labor in between January 2017 to June 2018 in Obstetrics/Gynae Department,Mahatma Gandhi Memorial Medical College Hospital, Jamshedpur, Jharkhand. All the cases were divided into two groups: group A-where baby delivered by the Patwardhan′s technique and group B- where baby delivered by “push” and “pull” method. Maternal morbidity in terms of uterine extensions, PPH, need for blood transfusions as well as neonatal morbidity was compared between two techniques. Result: Review of 100 patients shows that there was significant low rates of maternal morbidity in terms of uterine incision extensions, and other related complications with Patwardhan′s technique. However there was no difference in neonatal outcome in both the groups. Conclusion: The Patwardhan′s technique is superior and quite safe method for delivery of baby in second stage cesarean sections and has minimal complications if anticipated and done skillfully
ABSTRACT
Background: Caesarean sections done at full cervical dilatation with impacted fetal head are technically very difficult and are associated with increased incidence of maternal and fetal morbidities. The objective of this study was to compare the maternal and neonatal morbidities between the Patwardhan technique and the Push method for extraction of the fetus in second stage caesarean section. Methods: This is retrospective analysis of all caesarean sections done in the second stage at tertiary care centre at Dehradun, UK, India from 2014 to Dec 2016. Women with single fetus, with anterior vertex, at term with a deeply impacted fetal head into pelvis, in whom decision of caesarean section was already taken, were included in the study. Results: The patients were divided into two groups, Group 1 (study group) consists of all cases in which extraction of fetus was done by Patwardhan technique and group 2 (control) in whom extraction of fetus was done by push method and extracted as vertex. Complications like extension of the incision, injury to surrounding organs , PPH, need for blood transfusion and neonatal outcome in terms of weight , APGAR and NICU stay were compared in both groups Out of these 120 cases,56 belonged to group A .( Patwardhan) and 64 belonged to group B (push method ). Traumatic PPH and blood transfusions were significantly less in Patwardhan as compared to Push method (3%,16%,p=.0049). There were significantly less uterine incision extension seen in Patwardhan group as compared to Push method (5%, 22%, p=.0031).Baby outcome was almost similar in both the groups. While complications are inherent in both the techniques Patwardhan method has been shown to cover considerable advantage in prevention of maternal morbidities. Conclusions: Patwardhan is a useful manoeuvre in intra operative disengagement of fetal head in second stage CS and it should be learnt and practiced as the primary technique.