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The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
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External Cephalic Version: Is it an Effective and Safe Procedure?
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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
PubMed
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.

Keywords:
Cesarean sectionFetal head impactionImpacted fetal headPregnancy complications

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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.