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

Abstract

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.

Keywords: Birth injury; Birth trauma; Caesarean; Impacted fetal head; Instrumental delivery; Stillbirth.