Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Second-stage cesarean delivery (CD) is linked to increased subsequent preterm birth (PTB) risk.
• Cervical injury from uterine incision extension during CD may contribute to PTB.
• Reverse breech extraction may reduce uterine incision extensions compared to the "push" method.

Purpose of the Study:

• To investigate the association between fetal extraction method during second-stage CD and spontaneous preterm birth (sPTB) in subsequent pregnancies.
• To evaluate other maternal and neonatal outcomes related to extraction method.

Main Methods:

• Multicenter retrospective cohort study.
• Included women with singleton delivery post-second-stage CD (2004-2021).
• Compared "push" method vs. reverse breech extraction for fetal extraction; analyzed sPTB and other outcomes using logistic regression.

Main Results:

• 583 women met inclusion criteria; 234 (40.1%) used reverse breech extraction, 349 (59.9%) used the "push" method.
• No statistically significant difference in sPTB rates between groups (3.7% vs. 3.0%; aOR 1.27).
• Similar rates for overall PTB and other maternal/neonatal outcomes observed in both groups.

Conclusions:

• The method of fetal extraction during second-stage CD ("push" vs. reverse breech) did not significantly affect subsequent PTB rates.
• No significant differences in maternal or neonatal outcomes were found based on extraction method.