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

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.

Automated summary

This study investigated the incidence and complication rates of impacted fetal head at full dilatation Caesarean birth in the UK, as well as the techniques used. It was found that 16% of cases involved the use of a dis-impaction technique or reported difficulty in delivering the head. The most commonly used techniques were manual elevation of the head through the vagina and the use of a fetal pillow. Unfortunately, 2% of babies died or sustained severe injury.