Evaluation of Patwardhan Technique in Second Stage Caesarean Section

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.