Impacted head -How to deliever the impacted head in C S operation safely

What is Patwardhan Technique of delivering the impacted head-Shoulders to be delivered first(ant shoulder followed by post shoulder ) à Breechà lastly pull the impacted head—not by  push technique push by asstt from below. This situation arises only when   had is jammed deep or say impacted in pelvis with edematous thin almost friable lower segment

Step1: Delivery of ant. Shoulder intentionally In case of occipito-transverse or an occipito-anterior position with the head deeply impacted in the pelvis, incision is made in the lower uterine segment, at the level of the anterior shoulder, which is delivered out.

With gentle traction on this shoulder, the posterior shoulder is also delivered out.

Step 2:-Next, the surgeon hooks the fingers through both the axillae and with gentle traction, aided by fundal pressure applied by assistant, the body of the foetus is brought out of the uterus.

Step 3: Last is delivery of head by pull method àpull exerted through the neck , Now the baby’s head which is the only part of the foetus which is still inside the uterus, is gently lifted out of the pelvis.

Caesarean deliveries even in 2020 are being done in late second stage of labour in rural hospitals where laboring women report to hospital quite late in labour. . Earlier even in late ninties late second stage CS rate accounted for about  one-fourth of all primary caesarean sections . Be that as it may , Caesarean sections done at full cervical dilatation with impacted foetal heads are technically difficult and they are associated with an increased incidence of maternal and foetal morbidities. Extension of tears upto vaginal walls, B lig haematoma and PPH & P sepsis were to common.  Earlier up to sixties extraction of the impacted foetal head used to be  done by ‘push method’, i.e., pushing through the vagina . But from 1955 after the publication by  Patwardhan BD, Motashaw ND. Caesarean Section. J Obstet Gynecol India. 1957;8:1–15 the method of  “pull” method, i.e., a reverse breech technique became popular and eerier method of Push by Asstt from below decreed its popularity. This move was in the right direction.

However, both these methods are associated with an increased rate of maternal morbidity in the form of uterine extensions, postpartum haemorrhage and fever Patwardhan technique is a unique technique which is used for delivering babies in second stage caesarean sections

Extension of the uterine incision during lower segment caesarean sections is common in second stage of labour, when the hand is forcibly introduced into the pelvis to deliver the head which is impacted in the pelvis, since the lower uterine segment is edematous and fragile. Use of Patwardhan technique can prevent this maternal injury and it can thus reduce the need for blood transfusions. It also does not increase neonatal morbidity.