Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument

Abstract

Key content •There has been a disproportionate increase in caesarean section performed in the second stage of labour in the last few years. •Difficult delivery of the fetal head during caesarean section carries a higher risk of complications for both mother and baby. •The National Sentinel Caesarean Section Audit Report, published by the Royal College of Obstetricians and Gynaecologists recommends a consultant presence when caesarean section is performed at full dilatation. Learning objectives •The obstetrician needs to anticipate the possibility of difficult delivery of the fetal head during caesarean section. •Using an assistant to push the fetus can cause trauma, as the force required to push is uncontrolled. •The Foetal Disimpacting System® seems to be effective in elevating the fetal head when it is deeply engaged. Ethical issues •There is a need for more data before the fetal disimpacting device is adopted in routine obstetric practice. •Use of this device when preparing for an emergency caesarean section, for instance in a situation of umbilical cord prolapse, may be justified. Please cite this article as: Singh M, Varma R. Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument. The Obstetrician & Gynaecologist 2008;10:38–41.