SHIRALEE'S REMODIFICATION OF THE MODIFIED MAURICEAU-SMELLIE-VEIT MANOEUVRE FOR DELIVERING THE AFTERCOMING HEAD OF BREECH.

Background: In obstetrics, aftercoming head of breech poses a great challenge, and its entrapment is often an obstetrician's nightmare. In an attempt to avoid this unpleasant situation, many manoeuvres have come up namely Burns-Marshall, Mauriceau-Smellie-Veit (MSV) & its modification, Piper's forceps & the like. The aim of this study is to compare modified MSV technique with Shiralee's remodification of the same, in terms of efficacy, effectiveness, perinatal morbidity, and mortality. Materials and methods: A prospective comparative study was carried out over a period of two years in women who had singleton term breech vaginal delivery at Kamla Raja Maternity Wing, JA Group of Hospitals, Gwalior (M.P.), India. Available demographic variables, obstetric characteristics and perinatal outcomes were analyzed. Results: Out of 10,276 cases of deliveries during the study period, the incidence of term breech deliveries was 298 (2.9%) among which the mode of only 52 (17.5%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency caesarean section could not be performed. One parturient in the modified MSV group faced entrapment of aftercoming head, requiring Dührssen's incision. Adverse perinatal outcomes were seen in 26% of deliveries in Group 1 (modified MSV), whereas in only 14% of cases in Group 2 (SRMMSV). Thirty two percent of neonates had an APGAR score <7 at 5 minutes in Group 1, as compared to 20% newborns in Group 2. NICU admissions were 48% in the former and 28% in the latter. The incidence of birth injuries in the two groups was 16% & 8% respectively. There was one perinatal mortality in the modified MSV group & none in the SRMMSV group. Conclusion: The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities and contemporary practices, especially when the deliveries are not well planned. Shiralee's remodification of the modified MSV manoeuvre was found to be more efficacious with lesser perinatal morbidity, in comparison to the already existing MSV method. [ABSTRACT FROM AUTHOR]