Comparison of Fetomaternal Outcomes of Push vs Pull Technique in Second Stage Cesarean Section

Background: Management of an impacted fetal head during second-stage cesarean section presents significant fetomaternal challenges. Different delivery techniques, such as push and pull, may influence maternal and neonatal outcomes. Objective: To compare fetomaternal outcomes using the push versus pull technique for delivery of the impacted fetal head during second-stage cesarean section. Study Design: Randomized controlled trial. Setting: Conducted at the Department of Gynecology and Obstetrics at Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 11 February 2025 to 11 May 2025. Methods: A total of 224 pregnant women aged 15–45 years, with gestational age ≥37 weeks, cephalic presentation, singleton pregnancy, and a fully dilated cervix were enrolled. Patients were equally divided into two groups: Group A (n = 112) underwent the push technique, and Group B (n = 112) underwent the pull technique. Fetomaternal outcomes evaluated included uterine incision extension, need for blood transfusion, and neonatal APGAR score <7 at five minutes. Statistical analysis was performed using SPSS, with P < 0.05 considered significant. Results: Mean maternal age was 28.57 ± 7.87 years in Group A and 27.79 ± 8.44 years in Group B. Uterine incision extension occurred in 25.9% of the push group versus 8.9% in the pull group (P = 0.001). Blood transfusion was required in 10.7% of neonates versus 3.6% (P = 0.03), and low APGAR scores (<7) were noted in 16.1% versus 7.1% of neonates in the push and pull groups, respectively (P = 0.03). Conclusion: The pull technique demonstrated superior fetomaternal outcomes compared to the push technique for delivery of impacted fetal heads during second-stage cesarean sections, with lower rates of uterine incision extension, blood transfusion, and neonatal compromise.