Skip to main content

Research Repository

Advanced Search

Feasibility of a RCT of techniques for managing an impacted fetal head during emergency caesarean section: the MIDAS scoping study

Walker, Kate F.; Mitchell, Eleanor J.; Ayers, Susan; Jones, Nia W.; Ogollah, Reuben; Wakefield, Natalie; Dorling, Jon; Pallotti, Phoebe; Pillai, Arani; Tempest, Nicola; Plachcinski, Rachel; Bradshaw, Lucy; Knight, Marian; Thornton, Jim G.

Feasibility of a RCT of techniques for managing an impacted fetal head during emergency caesarean section: the MIDAS scoping study Thumbnail


Authors

KATE WALKER Kate.Walker@nottingham.ac.uk
Clinical Professor

Susan Ayers

Nia W. Jones

REUBEN OGOLLAH REUBEN.OGOLLAH@NOTTINGHAM.AC.UK
Associate Professor of Medical Statistics and Clinical Trials

Natalie Wakefield

Jon Dorling

Phoebe Pallotti

Arani Pillai

Nicola Tempest

Rachel Plachcinski

Marian Knight

Jim G. Thornton



Abstract

Background: Second-stage caesarean sections, of which there are around 34,000 per year in the United Kingdom, have greater maternal and perinatal morbidity than those in the first stage. The fetal head is often deeply impacted in the maternal pelvis, and extraction can be difficult. Numerous techniques are reported, but the superiority of one over another is contentious and there is no national guidance. Objective: To determine the feasibility of a randomised trial of different techniques for managing an impacted fetal head during emergency caesarean.Design: A scoping study with five work packages: (1) national surveys to determine current practice and acceptability of research in this area, and a qualitative study to determine acceptability to women who have experienced a second-stage caesarean; (2) a national prospective observational study to determine incidence and rate of complications; (3) a Delphi survey and consensus meeting on choice of techniques and outcomes for a trial; (4) the design of a trial; and (5) a national survey and qualitative study to determine acceptability of the proposed trial. Setting: Secondary care. Participants: Health-care professionals, pregnant women, women who have had a second-stage caesarean, and parents. Results: Most (244/279, 87%) health-care professionals believe that a trial in this area would help guide their practice, and 90% (252/279) would be willing to participate in such a trial. Thirty-eight per cent (98/259) of parents reported that they would take part. Women varied in which technique they thought was most acceptable. Our observational study found that impacted head is common (occurring in 16% of second-stage caesareans) and leads to both maternal (41%) and neonatal (3.5%) complications. It is most often treated by an assistant pushing the head up vaginally. We designed a randomised clinical trial comparing the fetal pillow with the vaginal push technique. The vast majority of health-care professionals, 83% of midwives and 88% of obstetricians, would be willing to participate in the trial proposed, and 37% of parents reported that they would take part. Our qualitative study found that most participants thought the trial would be feasible and acceptable. Limitations: Our survey is subject to the limitation that, although responses refer to contemporaneous real cases, they are self-reported by the surgeon and collected after the event. Willingness to participate in a hypothetical trial may not translate into recruitment to a real trial. Conclusions: We proposed a trial to compare a new device, the fetal pillow, with a long-established procedure, the vaginal push technique. Such a trial would be widely supported by health-care professionals. We recommend that it be powered to test an effect on important short term maternal and baby outcomes which would require 754 participants per group. Despite the well-known difference between intent and action, this would be feasible within the United Kingdom.

Citation

Walker, K. F., Mitchell, E. J., Ayers, S., Jones, N. W., Ogollah, R., Wakefield, N., …Thornton, J. G. (2023). Feasibility of a RCT of techniques for managing an impacted fetal head during emergency caesarean section: the MIDAS scoping study. Health Technology Assessment, 27(6), 1-87. https://doi.org/10.3310/KUYP6832

Journal Article Type Article
Acceptance Date May 19, 2022
Online Publication Date Mar 30, 2023
Publication Date Mar 30, 2023
Deposit Date May 10, 2023
Publicly Available Date Mar 28, 2024
Journal Health Technology Assessment
Print ISSN 1366-5278
Electronic ISSN 2046-4924
Publisher National Institute for Health and Care Research
Peer Reviewed Peer Reviewed
Volume 27
Issue 6
Pages 1-87
DOI https://doi.org/10.3310/KUYP6832
Keywords Health Policy
Public URL https://nottingham-repository.worktribe.com/output/19295608
Publisher URL https://www.journalslibrary.nihr.ac.uk/hta/KUYP6832#/abstract

Files




You might also like



Downloadable Citations