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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.

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


Natalie Wakefield

Marian Knight

Jon Dorling

Jim G. Thornton

Clinical Professor


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.

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 BV
Peer Reviewed Peer Reviewed
Volume 272
Pages 77-81
Keywords Caesarean; Instrumental delivery; Impacted fetal head; Birth trauma; Stillbirth; Birth injury
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