No method best to achieve delivery for Impacted fetal head during second stage of CS: EJOG
Caesarean section rates are increasing in countries. At least 5% are performed at full cervical dilatation (in the second stage of labour) and this proportion is rising. Both maternal and neonatal complications are greater during the second stage. One reason is that when the cervix is fully dilated, the baby's head may be deeply engaged in the pelvis, a so-called 'impacted fetal head'. Delivery in this situation may be technically challenging if the obstetrician cannot pass their hand between the bony maternal pelvis and the fetal head. A vacuum effect may also make head elevation difficult. The uterus is also typically thinned and stretched making extension of the uterine incision more likely. Complications for the baby include bony fractures, hypoxic brain injury and death. Risks of complications are further increased if there has been a prior unsuccessful attempt at instrumental birth.
Many different techniques have been advocated, including the Fetal Pillow; the Patwardhan method; the push technique; reverse breech extraction,tocolysis and the Tydeman tube but there are few data on how often they are used and which are most effective.
The aim of this study by N. Wyn Jones et al was to determine the incidence of, and complication rates from, impacted fetal head at full dilatation Caesarean birth in the UK, and record what techniques used are in use. This was performed as part of a wider scoping study commissioned by the National Institute for Health Research to determine the feasibility of designing a randomised trial comparing techniques for management of an impacted fetal head in the UK.
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