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

Abstract

ObjectiveTo 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. DesignProspective observational study using the UK Obstetric Surveillance System (UKOSS). Setting159 (82%) of the 194 UK hospitals with obstetric units. PopulationAll 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. MethodsProspective observational study. Main outcome measuresTechnique(s) used, maternal and neonatal outcomes. Results3,518 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). ConclusionsDifficulty 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.