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A New Indication for Breech Extraction
Author(s) -
Hassanien Tawhid
Publication year - 1999
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1999.tb03147.x
Subject(s) - caesarean section , breech presentation , medicine , spare part , forceps , section (typography) , general surgery , obstetrics , surgery , computer science , pregnancy , operations management , engineering , genetics , biology , operating system
EDITORIAL COMMENT: We accepted this paper for publication because the author describes a novel technique that may be useful at Caesarean section. It is noteworthy that this patient had a general anaesthetic, which in the editor's opinion is a very good idea when the head is deep in the pelvis and Caesarean section is decided upon. It is always wise in such cases where a spare pair of hands is available (e.g. midwife, medical student or theatre nurse) to have the person scrubbed up with a hand in the vagina so that when the uterus is incised the head can be pushed up from below. One can only agree with the author that the operator's hand alongside the head, when the uterus is already retracted, poses the risk of extension of the lower uterine segment incision and formidable haemorrhage. It is also wise of course to do a vaginal examination of the patient in labour after she is anaesthetized before Caesarean section because sometimes there has been jkrther unexpected progress since the last examination. The editor has done, and so will many of readers likewise have done, quite easy forceps deliveries under such circumstances when they had planned to do a Caesarean section. Only further information concerning a larger, number of patients will tell us whether breech extraction is always reasonably easily effected under the circumstances described in this patient. Probably the procedure is much easier when the patient has a general anaesthetic rather than epiduralanalgesia where the uterus is not relaxed. This type of delivery is a variety of internal version breech extraction except that the baby is being rotated out of the uterus rather than inside it. When the head is high at elective Caesarean section, many obstetricians, including the writer of this editorial comment, peorm internal version breech extraction to deliver the baby. Often this procedure is remarkably easy but sometimes it can be very dificult or impossible. This statement is made in case the, same may apply in the circumstances described in this patient. We need more a on this manoeuvre before the indication for its performance in a case of obstructed labour with the vertex presenting can be recommended. N.B.