Disengaging the deeply impacted fetal head during cesarean section

Abstract

Sir, It's a really challenging situation for the obstetrician to dislodge the impacted fetal head with least maternal and neonatal morbidity. A smiling incision on the uterus as mentioned by you in the letter definitely gives room for different maneuvers and decreases the complications such as extension. We follow this in our routine practice when we require more space especially for the delivery of large babies. In our study, the skin incision type used was based upon the preference and experience of the operating surgeon. We feel that the skin incision does not make much difference as a transverse incision gives more access to the pelvis. The use of clinical pelvimetry, monitoring of labor by the use of partogram and a second opinion from a senior colleague in case of doubtful cases, can decrease the incidence of an impacted head. As mentioned in the letter by Dr. Karasahin and colleagues, we require a study including a larger population for establishing the method of choice and formulating an optimal protocol for the management of such patients in future.