Outcomes of second stage cesarean section following the use of a fetal head elevation device: A systematic review and meta-analysis

Objectives: To explore maternal and perinatal outcomes of women undergoing full dilatation cesarean section (CS) who had compared to those who did not have application of fetal head elevation device (FHED). Material and methods: Pubmed, Embase, Cinahl, Clinical Trial.Gov and Google Scholar databases were searched. Inclusion criteria were studies exploring maternal and perinatal outcomes in women having compared to those not having FHED at full dilatation CS. The outcomes explored were: hysterotomy to delivery time (sec), mean estimated blood loss (ml), blood loss > 1000 mL, need for blood transfusion, uterine incision extension, operative complications, need for re-operation, urinary retention, hospital readmission, length of in hospital stay, Apgar score < 3 at 1 min, Apgar score < 7 at 5 min, neonatal arterial Ph, arterial pH < 7.1, admission to neonatal intensive care unit (NICU), neonatal sepsis, need for neonatal endotracheal intubation, neonatal death. Random effect head-to-head meta-analyses combining summary mean difference (MD), and odd ratio (OR) were used to analyze the data. Results: Ten studies (1326 women) were included. The mean time from hysterotomy to delivery was lower in women having compared to those not having FHED (MD:-52.26 s, 95 % CI-55.2 to-34.94, p < 0.001). Women who had FHED had also a lower mean estimated blood loss (MD:-130.82 mL, 95 % CI-130.1 to-381.0; p < 0.001) and a shorter stay in the hospital (MD:-0.884 h, 95 % CI-1.07 to-0.70; p < 0.001) compared to controls. Pregnant women having FHED at full dilatation CS had a lower risk of uterine incision extension (OR: 0.50, 95 % CI 0.3 to 0.9; p = 0.02), need for blood transfusion (OR: 0.39, 95 % CI 0.2 to 0.7; p = 0.04) and operative complications (OR: 0.44, 95 % CI 0.2 to 0.9; p = 0.03) compared to controls, while there was no difference in the other maternal outcomes between the two groups. When exploring perinatal outcome, women who received FHED had higher mean arterial pH values (MD: 0.617, 95 % CI 0.43 to 0.88; p < 0.001) and a lower risk of neonatal sepsis (OR: 0.10, 95 % CI 0.01 to 0.99; p = 0.05) and admission to NICU (OR: 0.63, 95 % CI 0.5 to 0.9; p = 0.008) compared to controls. Conclusion: Application of FHED at full dilatation CS seems to be associated with improvement in some maternal and neonatal outcomes. (c) 2021 Published by Elsevier B.V.

Automated summary

The study found that applying fetal head elevation device (FHED) during full dilatation cesarean section can reduce the time from hysterotomy to delivery, decrease estimated blood loss, and shorten hospital stay. It also lowers the risks of uterine incision extension, blood transfusion, and operative complications. In terms of perinatal outcomes, women who received FHED had higher arterial pH values and lower risks of neonatal sepsis and admission to NICU.