During a cesarean section performed for non-reassuring fetal heart pattern, the uterine incision is made and the fetal head is deeply engaged but difficult to deliver. The 'pull' method (reverse breech extraction) is used. What is the correct technique for this maneuver?
- A The operator's hand is introduced into the uterus, the fetus is grasped by both feet, and the fetus is extracted breech first through the incision ✓
- B An assistant pushes the fetal head upward from the vagina while the operator pulls from above
- C The vacuum extractor is reapplied inside the uterus to assist delivery
- D The uterine incision is extended vertically to increase space for extraction
Correct answer: A. The operator's hand is introduced into the uterus, the fetus is grasped by both feet, and the fetus is extracted breech first through the incision
Explanation
The 'pull' method (reverse breech extraction) involves introducing a hand into the uterus, grasping both fetal feet, and extracting the fetus breech first through the uterine incision. This is indicated when the head is deeply engaged and difficult to disimpact for the 'push' method. Option B describes the 'push' method. Option C is incorrect as vacuum inside the uterus is dangerous. Option D (extending to classical incision) is done only if absolutely necessary but is not the pull method itself.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.