A cesarean section is being performed for fetal distress at full dilation. Difficulty is encountered extracting the fetal head. The 'push' method (an assistant pushes the fetal head up vaginally) is associated with complications. What is the recommended alternative technique (Patwardhan's maneuver)?

• A Trunk is delivered first with arms extracted, then head last in all-four-limb delivery
• B Reverse breech extraction: feet are grasped and trunk delivered followed by flexed head delivery ✓
• C Fetal head is disimpacted vaginally by reverse Smellie-Veit maneuver before abdominal extraction
• D Symphysiotomy to widen the pelvic outlet before uterine incision

Explanation

Patwardhan's maneuver is used for cesarean delivery of a deeply impacted fetal head. In this technique, after the uterine incision, the surgeon grasps the anterior shoulder (or feet in complete breech presentation variant) and delivers the body in breech fashion first—the trunk and limbs are extracted, and finally the after-coming head is delivered by neck flexion (similar to Mauriceau-Smellie-Veit for vaginal breech). This avoids the complications of the 'push' method (uterovaginal injury, maternal lacerations, neonatal trauma). Option A describes a sequential limb delivery used in certain breech variants but is not the standard Patwardhan description. The classic Patwardhan is a reverse breech extraction through the cesarean uterine incision.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.