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Impacted fetal head at cesarean delivery
Sophie C Ragbourne1, Elinor Charles1, Maria Herincs1
1Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Journal of Clinical Anesthesia
|September 14, 2024
Summary
Impacted fetal head (IFH) during cesarean delivery presents challenges, with incidence varying widely. Anesthesiologists play a key role in managing IFH, with proposed algorithms to guide emergency interventions and improve outcomes.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Maternal-Fetal Medicine
Background:
- Impacted fetal head (IFH) is defined as deep fetal head engagement during cesarean delivery, complicating extraction.
- This condition poses significant challenges for the surgical and anesthetic teams.
Purpose of the Study:
- To review the incidence, risk factors, management strategies, and complications of IFH in cesarean delivery.
- To highlight the anesthesiologist's role in managing IFH as part of a multidisciplinary team.
Main Methods:
- A narrative review of databases was conducted.
- Searches included keywords and subject headings related to IFH and cesarean delivery up to January 2023.
Main Results:
- IFH incidence ranges from 2.9-71.8% in emergency cesarean sections.
- Risk factors include advanced labor, epidural analgesia, instrumental delivery attempts, fetal malposition, and caput succedaneum.
- Management involves simple interventions like operating table adjustments and tocolysis; complications include postpartum hemorrhage and neonatal hypoxic brain injury.
Conclusions:
- Anesthesiologists are crucial for facilitating delivery in IFH cases.
- An evidence-based management algorithm is proposed for this emergency situation.
