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Impacted fetal head during second stage Caesarean birth: A prospective observational study
Nia Wyn Jones1, Eleanor J Mitchell2, Natalie Wakefield3
1Clinical Associate Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Division of Population and Lifespan Sciences, University of Nottingham, UK.
Objective:
To determine the incidence of, and complication rates from, impacted fetal head at full dilatation Caesarean birth in the UK, and record what techniques were used.
Design:
Prospective observational study using the UK Obstetric Surveillance System (UKOSS).
Setting:
159 (82%) of the 194 UK hospitals with obstetric units.
Population:
All women who underwent second stage Caesarean birth in the UK between 1st March and 31st August 2019. Further information was collected on cases where a dis-impaction technique was used, or the operating surgeon experienced 'difficulty' in delivering the head.
Methods:
Prospective observational study.
Main Outcome Measures:
Technique(s) used, maternal and neonatal outcomes.
Results:
3,518 s stage Caesarean births reported. The surgeon used a dis-impaction technique or reported 'difficulty' in 564 (16%) of these. The most common dis-impaction techniques used were manual elevation of the head by an assistant through the vagina (n = 235) and a fetal "pillow" (n = 176). Thirteen babies (2%) died or sustained severe injury. Four babies died (two directly attributable to the impacted fetal head).
Conclusions:
Difficulty with delivery of the fetal head and the use of dis-impaction techniques during second stage Caesarean sections are common but there is no consensus as to the best method to achieve delivery and in what order.
