Impacted fetal head during second stage Caesarean birth: A prospective observational study

Wyn Jones, Nia; Mitchell, Eleanor J.; Wakefield, Natalie; Knight, Marian; Dorling, Jon; Thornton, Jim G.; Walker, Kate F.

Abstract

Objective: To determine the incidence of, and complication rates from, impacted fetal head at full dilatation Caesarean birth in the UK, and record what techniques were used. Design: Prospective observational study using the UK Obstetric Surveillance System (UKOSS). Setting: 159 (82%) of the 194 UK hospitals with obstetric units. Population: All women who underwent second stage Caesarean birth in the UK between 1st March and 31st August 2019. Further information was collected on cases where a dis-impaction technique was used, or the operating surgeon experienced ‘difficulty’ in delivering the head. Methods: Prospective observational study. Main outcome measures: Technique(s) used, maternal and neonatal outcomes. Results: 3,518 s stage Caesarean births reported. The surgeon used a dis-impaction technique or reported ‘difficulty’ in 564 (16%) of these. The most common dis-impaction techniques used were manual elevation of the head by an assistant through the vagina (n = 235) and a fetal “pillow” (n = 176). Thirteen babies (2%) died or sustained severe injury. Four babies died (two directly attributable to the impacted fetal head). Conclusions: Difficulty with delivery of the fetal head and the use of dis-impaction techniques during second stage Caesarean sections are common but there is no consensus as to the best method to achieve delivery and in what order.

Citation

Wyn Jones, N., Mitchell, E. J., Wakefield, N., Knight, M., Dorling, J., Thornton, J. G., & Walker, K. F. (2022). Impacted fetal head during second stage Caesarean birth: A prospective observational study. European Journal of Obstetrics and Gynecology and Reproductive Biology, 272, 77-81. https://doi.org/10.1016/j.ejogrb.2022.03.004

• Journal Article Type: Article
• Acceptance Date: Mar 1, 2022
• Online Publication Date: Mar 3, 2022
• Publication Date: May 1, 2022
• Deposit Date: Mar 14, 2022
• Publicly Available Date: Mar 16, 2022
• Journal: European Journal of Obstetrics and Gynecology and Reproductive Biology
• Print ISSN: 0301-2115
• Electronic ISSN: 1872-7654
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 272
• Pages: 77-81
• DOI: https://doi.org/10.1016/j.ejogrb.2022.03.004
• Keywords: Caesarean; Instrumental delivery; Impacted fetal head; Birth trauma; Stillbirth; Birth injury
• Public URL: https://nottingham-repository.worktribe.com/output/7603737
• Publisher URL: https://www.ejog.org/article/S0301-2115(22)00236-6/fulltext
• Related Public URLs: https://www.sciencedirect.com/science/article/pii/S0301211522002366