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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.
Summary
Impacted fetal head during Caesarean birth is common, affecting 16% of cases. While techniques exist to dis-impact the head, there
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes Research
Background:
- Impacted fetal head during Caesarean birth presents a significant challenge in obstetrics.
- Understanding the incidence and management of this complication is crucial for improving maternal and neonatal outcomes.
Purpose of the Study:
- To determine the incidence of impacted fetal head during full dilatation Caesarean birth in the UK.
- To record complication rates associated with impacted fetal head.
- To document the techniques employed for fetal head dis-impaction.
Main Methods:
- A prospective observational study was conducted using the UK Obstetric Surveillance System (UKOSS).
- Data were collected from 159 UK hospitals between March and August 2019.
- Information on dis-impaction techniques and delivery difficulties was recorded for women undergoing second-stage Caesarean births.
Main Results:
- Out of 3,518 second-stage Caesarean births, 16% (564 cases) involved difficulty delivering the fetal head or required dis-impaction.
- Common dis-impaction techniques included manual head elevation (235 cases) and fetal pillow use (176 cases).
- A total of 13 babies (2%) experienced severe injury or death, with four deaths directly linked to the impacted head.
Conclusions:
- Difficulty with fetal head delivery and the use of dis-impaction techniques are frequent occurrences in second-stage Caesarean sections.
- There is currently no established consensus on the optimal dis-impaction method or sequence for managing impacted fetal heads.
