Comparison of maternal and neonatal complications of fetal delivery by cesarean section in three methods: cephalic, breech and anterior shoulder in deeply engaged fetal head

Caesarean section in deeply engaged fetal head is done by cephalic or breech method and these two methods are associated with maternal and neonatal complications. The present study was performed with aim to compare the maternal and neonatal complications of cesarean section in anterior shoulder method, cephalic and breech methods.

This clinical trial study was carried out in 2020-2021 on 111 mothers referred for delivery in Omolbanin hospital of Mashhad. They had inclusion criteria and consent to participate in the study. Cesarean section was performed in three groups of 37 people: cephalic, breech and anterior shoulder method. The duration of surgery, amount of bleeding, extension of incision, bladder trauma, uterine vessels trauma, Apgar score, newborn's trauma, need to NICU admission, and duration of mother and newborn hospitalization were compared in three groups. Data were analyzed by SPSS software (version 25) and ANOVA, Kruskal-Wallis and chi-square tests. P<0.05 was considered statistically significant.

Among maternal complications, extension of uterine incision (p=0.008) and trauma to uterine vessels (P=0.033) was less in the anterior shoulder group than the other two groups and the difference was significant. There was no significant difference between the three groups in neonatal complications, only pH of the umbilical cord blood of the newborns was significantly different between the three groups (p=0.035). Based on the results of Mann-Whitney post hoc test, the cord blood pH of infants in the anterior shoulder group was significantly higher than the cephalic (p=0.023) and breech (p=0.037) groups.

Cesarean section in deeply engaged fetal head with the anterior shoulder method had less maternal complication include extension of uterine incision and trauma to the uterine vessels. In this study, there was no significant difference between the three groups in neonatal complications, and only the neonatal cord blood pH in the anterior shoulder group was better than the other two groups, so it is safe to choose the anterior shoulder method in this type of cesarean section.