Objectives: To assess the safety and feasibility of a novel technique, External Pop-out (EPO), for supporting the lower
uterine segment during fetal head extraction in cesarean section (CS).
Study design: Prospective cohort study.
Patients and Methods: The current research is a registered (NCT02755168) study compassing the new technique, EPO,
for head extraction during CS. The technique was performed on single, living, cephalic, elective cesarean deliveries at
Women's Health Hospital, Assiut University, Egypt. The primary study outcomes were; the feasibility and the rate of
incision extensions with the External Pop-out technique. The secondary outcomes included the easiness score and the
learning curve of this technique on five senior obstetricians' trainee.
Results: The EPO technique was successful in 845/877 cases (96.3%) but impossible in the remaining 32 case because of
extensive pelvic adhesions. The rate of occurrence of minor extensions associated with EPO was 8/845 (0.95%) with no
major extensions in succeeded cases. There was a statistically significant difference between the mean of easiness score in the early 5 cases and the next 5 cases in 4 out of 5 trainees. The remaining trainee reported a higher easiness score earlier from his 4th case. The mean of total scores in the late cases was also significantly higher than the early cases (p=0.0001).
Conclusions: External Pop-out technique is feasible with low rates of uterine incisions extensions. Moreover; this
technique is easily learned and performed by obstetricians