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Difficult fetal extraction in cesarean section: Number 8 - 2024
Álvaro Luiz Lage Alves1, Alexandre Massao Nozaki2, Lucas Barbosa da Silva3
1Universidade Federal de Minas Gerais Hospital das Clínicas Belo HorizonteMG Brazil Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Summary
Difficult fetal extraction during cesarean section, often due to impacted or floating fetal heads, carries significant maternal and neonatal risks. Evidence for management techniques is limited, highlighting a need for further research into safer delivery methods.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatal Care
Background:
- Difficult fetal extraction during cesarean section is a critical obstetric challenge.
- Key causes include deeply impacted fetal head and floating fetal presentation.
- Current evidence on management techniques and outcomes is primarily based on limited case reports and expert opinions.
Purpose of the Study:
- To review the causes and complications of difficult fetal extraction during cesarean section.
- To analyze maternal and neonatal outcomes associated with different management techniques.
- To identify areas lacking scientific evidence in managing these challenging deliveries.
Main Methods:
- Literature review of case reports, case series, and expert opinions on difficult fetal extraction during cesarean section.
- Analysis of reported maternal complications, including uterine lacerations, hematomas, and injuries to adjacent structures.
- Evaluation of reported neonatal complications, such as intracranial hemorrhage, fractures, nerve injuries, and perinatal asphyxia.
Main Results:
- Deeply impacted fetal head is linked to prolonged labor, failed operative vaginal delivery, and severe maternal complications (e.g., uterine vessel injury, urinary tract damage).
- Neonatal risks associated with impacted fetal heads include intracranial hemorrhage, fractures, and perinatal death.
- The abdominovaginal delivery (push method) appears to correlate with higher maternal and neonatal complications compared to other maneuvers.
- Internal podalic version followed by pelvic extraction is described for non-insinuated, floating fetal heads, distinct from reverse breech extraction.
Conclusions:
- Management of deeply impacted fetal heads during cesarean section poses substantial maternal and neonatal risks.
- The abdominovaginal delivery technique requires careful consideration due to associated complications.
- Further robust scientific evidence is needed to guide optimal management strategies for difficult fetal extraction during cesarean section.
