الفهرس 
Cesarean SectionOnly 14 pages are availabe for public view
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Abstract
Cesarean delivery is the most common and major obstetric operative procedure worldwide and cesarean rate has been continuously increased. Cesarean section is defined as the surgical termination of pregnancy or delivery by operative opening of uterus.
This procedure has different techniques to minimize morbidity and to reduce complications.
There are, however, important clinical differences between an elective cesarean delivery and a primary cesarean performed during active labor. First, with elective cesarean the lower uterine segment has not been effaced and elongated by the forces of labor and it may be more difficult to create an adequate incision for passage of the fetal head. Second, at the time of elective cesarean delivery the fetal head is commonly ”floating” above the pelvic brim (unengaged with respect to the maternal pelvis).Several methods have been described for the delivery of the fetal head at the time of elective cesarean delivery. The most common is simple manual delivery. If this proves to be difficult, the surgeon will ask for the use of an instrument to facilitate the delivery of the fetal head.
The present study is a RCT (randomized control trial) was conducted at Ain Shams University Maternity Hospital After getting approval from the ethical committee of the department of the obobstetrics and gynecology, Faculty of Medicine, Ain Shams University. And Informed consent were taken from all participants before recruitment in the study with explaining the purpose of the study.to compare 2 methods of delivery of the fetal head (forceps-assisted versus manual delivery) at time of elective cesarean section as regards unintended extension of the uterine incision, hemoglobin change 24 hours after cesarean section.
Patients underwent elective caesarean section were recruited for this trial. All patients were informed about the purpose of the trial, the operation modalities, and their benefits as well as risks. Patients were asked whether they are prepared to participate in the trial prior to their inclusion. After being screened for the inclusion and exclusion criteria eligible patients were included into the trial.
The selected cases were subjected to the following : 1. An informed consent: 2. Detailed history taking. 3. Clinical Examination: General examination: pulse, temperature, blood pressure, body weight and height, body mass index. b) Abdominal examination: by inspection, and palpation for assessment of fundal level, amount of liquor, fetal lie and presentation, fetal heart sounds, and scar of previous surgeries. 4. Ultrasonography to calculate gestational age, fetal growth, amniotic fluid and exclude any congenital malformation. 5. Lab. Investigations: C.B.C, Rh, blood grouping and albumin in urine.
After the data were tabulated and statistically analysed we found that there was no significant difference between group 1 and 2 cases as regard mean age and history of abortion. However a sigsignificant difference between group 1 and 2 cases was found regarding parity as the majority of group 1 cases were P2 (75.3%) compared to 54% only of group 2 cases.
Also there was a significant difference between group 1 and 2 cases as regard mean Uterine Wound Extension, with higher mean among group 1 cases (2.6 Vs 1.6)
However there was no significant correlation between each of age, parity, number of abortion, and Hb% 24h after operation.However, a significant negative correlation was detected between Uterine Wound Extension and Hb% 24h after operation.
Thus from the present study we can concluded that Forceps is better than and has less complications than manual delivery of the fetal head at time of elective cesarean section as regards unintended extension, hemoglobin change 24 hours after cesarean section.