A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

Anastasia Martin,Diane Nzelu,Andrew Shennan,Graham Tydeman,Annette Briley

doi:10.1186/s12884-021-04322-2

Anastasia Martin, Diane Nzelu + Show 3 more

Open Access

https://doi.org/10.1186/s12884-021-04322-2

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Abstract

BackgroundThe rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant.MethodsWe measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blindedResultsThe trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44).With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001).ConclusionOn a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

Highlights

Over the last two decades, the rate of caesarean section (CS) has risen significantly [1] with CS at full dilatation approximately doubling [2]
The Fetal Pillow (FP) achieved similar elevation to the digital technique, especially when the user was trained in the procedure
For day one, measurements were repeated in 15 training sessions in all those who attended. 90 paired measurements between digital elevation and each test device were obtained (24 for mild, 36 for moderate and 30 for severe settings on the simulator)

Summary

Introduction

Over the last two decades, the rate of caesarean section (CS) has risen significantly [1] with CS at full dilatation approximately doubling [2]. A more than doubling in rates of both bowel or bladder injuries and extension of the uterine incision, and higher rates of neonatal admissions are reported [4, 5, 7]. These reflect the consequences of prolonged labour and the need for disimpaction of the fetal head from the maternal pelvis prior to delivery through the maternal abdomen [4, 6, 8]. The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant

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