{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:09:15Z","timestamp":1789762155039,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,8,24]],"date-time":"2015-08-24T00:00:00Z","timestamp":1440374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Second\u2010stage caesarean section with a deeply impacted fetal head is associated with maternal and neonatal complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Systematic review and meta\u2010analysis to identify, appraise and synthesise existing evidence that evaluated various techniques of delivering a baby with a deeply impacted head at full\u2010dilation caesarean section. The primary outcome was uterine extension and secondary outcomes were other maternal and neonatal morbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>Online searches of <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content> (1946\u2013January\u00a02015), <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> (1950\u2013January\u00a02015), Web of Sciences (1950\u20132015), and the Cochrane Library databases were performed using a set of relevant keywords.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>All studies that compared the outcome of various techniques of delivering the baby's head at full\u2010dilation caesarean section.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Methodological quality was assessed using the Newcastle\u2013Ottawa scale. Data collected from each of the studies included variables on the participants, comparisons used, and feto\u2010maternal outcomes. Meta\u2010analysis was performed using <jats:sc>review manager<\/jats:sc>\u00a05.3.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>In total, 12 studies were included. Six studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a0455) examined primary outcomes. Meta\u2010analysis showed that the risks of uterine incision extension, infection, mean blood loss, and operative time were significantly higher with the push technique compared with the reverse breech extraction. The evidence to support the Patwardhan method and fetal pillow was inadequate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Authors' conclusions<\/jats:title><jats:p>Evidence gathered from observational studies suggests that reverse breech extraction is associated with significantly lower maternal risks compared with the push method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Meta\u2010analysis suggests reverse breech extraction during caesarean section to deliver impacted fetus is safer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13593","type":"journal-article","created":{"date-parts":[[2015,8,24]],"date-time":"2015-08-24T23:57:00Z","timestamp":1440460620000},"page":"337-345","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"123","author":[{"given":"YB","family":"Jeve","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OB","family":"Navti","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Hospitals of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JC","family":"Konje","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Hospitals of Leicester Leicester UK"},{"name":"Reproductive Sciences Section Department of Cancer Studies and Molecular Medicine Leicester Royal Infirmary University of Leicester Leicester UK"},{"name":"Center of Excellence in Reproductive Sciences Department of Obstetrics and Gynecology Sidra Medical and Research Center Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,8,24]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Hospital Episode Statistics Analysis HaSC Information Centre.NHS Maternity Statistics\u2013England 2013\u201314. 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