Patwardhan Technique Reduces Maternal Complications in Impacted Fetal Head During Second-Stage LSCS: IJOGR

A second stage caesarean section is associated with increased trauma to the lower uterine segment and surrounding structures, as well as heightened risks of postpartum hemorrhage (PPH), obstetric hemorrhage, bladder injury, and extended uterine incisions, which may result in broad ligament hematoma, infection, and prolonged hospital stays. Furthermore, second stage caesarean sections are linked to a higher likelihood of preterm deliveries in subsequent pregnancies.

Due to the anxiety stemming from their previous unsuccessful attempt at a normal vaginal delivery, they choose to undergo an elective cesarean section in their next pregnancy and postpone the possibility of a vaginal birth after cesarean (VBAC).

The primary aim of this study was to evaluate the feto-maternal outcomes associated with the Patwardhan technique in comparison to the conventional push method during the second stage of lower segment cesarean section (LSCS). The secondary objectives include

investigating the causes, intraoperative complications, and postoperative consequences of second stage LSCS. This study was a prospective comparative observational analysis that includes all pregnant women in the second stage of labor with a singleton pregnancy admitted to the labor room from June 2022 to December 2023. Participants are categorized into Group A, where the Patwardhan technique is applied, and Group B, where the Push technique is utilized for fetal extraction. The feto-maternal outcomes between the two groups are compared and evaluated.

A total of 100 cases were included in this study, with 50 cases undergoing the Patwardhan technique and 50 cases utilizing the Push technique for extraction. The results indicated a significantly longer duration of the procedure (58 minutes 54 seconds for the Patwardhan technique versus 51 minutes 58 seconds for the Push technique, P < 0.0001), a higher incidence of uterine angle extensions (52% in the Push group compared to 14% in the Patwardhan group, P < 0.000053), a greater occurrence of angle hematoma (26% versus 4%, P < 0.002), and an increased need for postoperative blood transfusion (75% in the Push group versus 25% in the Patwardhan group, P < 0.00001). Additionally, infants born in the Push group had a significantly higher rate of NICU admissions (52% compared to 24%, P < 0.0039) and lower APGAR scores at 1 minute; however, the overall final outcomes were comparable to those achieved with the Patwardhan technique.

The incidence of second stage C-sections is increasing, and this research indicated that this trend is contributing to notable maternal and fetal morbidity. This study revealed that the primary indications for such procedures include arrest of descent, unsuccessful ventouse-

assisted delivery, and deep transverse arrest. Furthermore, women who experienced fetal extraction via the Patwardhan method, in conjunction with the push technique, demonstrated improved outcomes regarding intraoperative complications such as uterine angle extension, uterine angle hematoma, postpartum hemorrhage, and the necessity for extended catheterization.

The likely reasons for the heightened occurrence of uterine angle extension in the group utilizing the push method for fetal extraction may stem from iatrogenic trauma inflicted by the operating surgeon while maneuvering their hand between the obstructed lower segment and the impacted fetal head. Conversely, the Patwardhan technique entails a partial reverse extraction, beginning with the shoulder, followed by the trunk and breech, and concluding with the head. In this method, the surgeon refrains from inserting their hand into the cavity or exerting unnecessary force. This research indicates that fetuses extracted using the push technique experienced a higher rate of NICU admissions and lower APGAR scores at one minute when compared to those in the Patwardhan group; however, there was no significant difference noted in neonatal mortality rates.

Source: Akkalkot and Hemalatha K R / Indian Journal of Obstetrics and Gynecology Research 2026;13(2):315–320