Pushing from below increases maternal complications
A study published in BMC Pregnancy and childbirth ‘Maternal and neonatal outcome of reverse breech extraction of an impacted fetal head during caesarean section in advanced stage of labor: a retrospective cohort study’ has found some significant differences in outcomes when comparing ‘pushing from below’ and reverse breech delivery of a baby with an impacted fetal head.
The retrospective study conducted in Switzerland analyzed the outcomes of 629 women whose baby was delivered via cesarean section in the later stages of labor. If difficulty was faced in disimpacting the fetal head either the reverse breech technique or head pushing was used. 82 women were in the head pushing group and 55 in the reverse breech.
The study found that outcomes were improved for women in the reverse breech group. They had lower uterine extension rates, a shorter operating time and less blood loss. There was no significant difference in the fetal outcomes however 2 babies in the head pushing group suffered skull fractures, one of which resulted in death.
The paper highlighted:
‘The deeply impacted fetal head is an obstetrical emergency situation, which requires a secure delivery technique to prevent undesirable maternal and neonatal consequences’
The full paper is available here.
Maternal and perinatal deaths dis-proportionally high following cesarean section in low- and middle-income countries.
The Lancet has published a study titled ‘Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis’.
The systematic review including 196 studies from 67 different countries looked at the risk of mortality in women who have had a cesarean section in low and middle income countries; estimating the cesarean deaths as a proportion of all deaths, the number of stillbirths and perinatal deaths along with risk of morbidity.
The review found that the cesarean section rate in most of the countries in the review was less than 10% with almost one quarter of cesareans being done for non-progress of labor. Findings for the rate of deaths per 1000 for those undergoing cesarean section were:
The review also found that women undergoing an emergency cesarean section were twice as likely to die than those undergoing an elective cesarean. A third of all the maternal deaths were attributed to post-partum haemorrhage and those cesareans performed in the second stage of labor were at higher risk of complications.
The study concludes:
‘The risk of maternal death following caesarean section is disproportionately high in LMICs, and women in sub-Saharan countries have the worst outcomes. The risks do not appear to have reduced over the past nearly 30 years, and are high in countries with a low rate of caesarean sections. Offspring outcomes are poor after a caesarean section, with high stillbirth and perinatal mortality. Emergency caesarean sections, particularly when undertaken in the second stage of labor, is a major risk factor for maternal and perinatal deaths, maternal near miss, and other major complications.’
The full study is available here.
Cesarean delivery associated with higher morbidity for women over 35
In a study titled ‘Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: a population-based propensity score analysis’ researchers looked at 6 regions across France covering 119 maternity units. A total of 4908 women were part of the study.
In those women with maternal morbidity over 85% of women had a post-partum haemorrhage with an increased risk of severe maternal morbidity for women with cesarean deliveries during labor. The risk of maternal morbidity for women with cesarean section before labor was significantly higher only for women over 35.
The study highlights that cesarean section was associated with a significantly higher risk of severe morbidity when compared to vaginal delivery. The risk for women over 35 was particularly significant for those undergoing cesarean both before and during labor.
It is important to recognize and evaluate both the risks and benefits when performing a cesarean section.
The full study is available here.