BCMS Medical Record Fall 2020 - 39

Efficacy and Safety Comparison
of an Innovative Two-Handed vs
One-Handed Technique for Fetal
Head Extraction during Low
Transverse Cesarean Section
Tara Lamb, MS, Xuezhi Jiang, MD, PhD
OBJECTIVE: The conventional one-handed technique has been the
standard procedure used for delivering fetal head during a cesarean
section. The use of the two-handed method, which is an innovative
approach to manual head extraction, with surgeon's both hands
formed as a pair of forceps, is now hypothesized to be comparable
to the conventional one-handed method in the efficacy and safety
of the maneuver. The new technique may also eliminate the fundal
pressure used originally in the one-handed option, leading to less
discomfort for the mother. The increased grasp of the head of the
fetus with two hands may decrease the need for other instrumental
interventions such as forceps and vacuum. The objective of the study
is to compare the effectiveness and safety of two-handed technique
with one-handed approach.
METHOD: The research design of this study was split into two
phases. Phase I was a prospective case study series for safety of
data collection. Ob/Gyn residents were trained in the two-handed
technique in a stimulation lab. Before being allowed to operate on
real patients, residents had to be approved by the study primary
investigator. Phase II was a randomized control study that included
two study groups (one-handed vs two-handed technique) and
measured the duration (seconds) from hand insertion into uterine
incision to fetal head delivery (U-D interval). Subject had to meet
specific criteria before being considered and informed consent was
needed in order to perform the study. A group of twelve patients was
recruited and consented. Eleven were completed with one excluded
due to breech position. One-handed group had eight and twohanded group had three patients. Data was analyzed using two tailed
Nonparametric Mann Whitney U test and multiple linear regression
model.
RESULTS: There were no maternal or neonatal complications in
both phases of the study. Mean (SD) for duration of hand insertion
into uterine incision-hand delivery was significantly longer for
one-handed extraction than two-handed extraction (14.94[10.77]
vs. 3.33[0.56] seconds, p<.014). A multiple linear regression was
calculated to predict U-D interval with head extraction technique
along with other covariates (age, BMI, surgeon's glove size, birth
weight). Both hand extraction technique and age were significant
predictors for U-D interval and two-handed technique reduces U-D
interval by 10.3 seconds with 95% confidence interval of 2.2-18.3
seconds.

significantly quicker than one-handed technique for U-D interval,
with a comparable safety profiles to one-handed approach.
Tara Lamb is a graduate of Binghamton University in
Binghamton, NY, holds a Master of Science degree from
Drexel University, and is currently a second-year medical
student at the Drexel University College of Medicine,
Philadelphia, PA where she serves as a Diversity Ambassador
and as Fundraising Chair for the Student National Medical
Association. She also volunteers with multiple programs
within Drexel's Health Outreach Project.

A Systematic Literature Review of
the Association Between Somatic
Symptom Disorder and Antisocial
Personality Disorder
Eduardo D. Espiridion, MD, DFAPA, CPE,
Chairman of Psychiatry Department,
Reading Hospital - Tower Health
and Stacie Kerbel
ABSTRACT
Somatic symptom disorder (SSD) and antisocial personality
disorder (APSD) are found at higher rates within families
compared to the general population. Both disorders are
characterized by low serotonin levels, which may be attributed
to polymorphisms in the dopa decarboxylase (DDC) gene.
The polymorphism rs11575542 of the gene leads to decreasing
the efficiency of aromatic l-amino decarboxylase (AADC) and
serotonin levels in a person. The polymorphism is also associated
with the development of somatic symptoms and sensationseeking behavior, a trait underlying APSD. Hence, the role of
this polymorphism as an underlying feature that may predispose
a person to develop APSD or SSD should be explored further in
future studies.
Stacie Kerbel is a graduate of the Schreyer Honors
College of Penn State University, University Park, PA and
is currently working towards a Master of Public Health
degree at the Penn State University College of Medicine,
Hershey, PA. Her community involvement includes
volunteer work in the Emergency Room at Grandview
Hospital in Sellersville, work with the Foundation for
International Medical Relief for Children, and with the
Penn State Health and Wellness Coalition.
continued on next page >

CONCLUSION: Study recruitment was significantly impacted by
COVID-19 pandemic and study is still ongoing. The sample size
is too small to allow investigators to draw a concrete conclusion.
The preliminary results suggest that two-handed technique was
FALL 2020

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BCMS Medical Record Fall 2020

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