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.

Birth injury, Birth trauma, Caesarean, Impacted fetal head, Instrumental delivery, Stillbirth

10.1016/j.ejogrb.2022.03.004

0301-2115

77-81

Wyn Jones, Nia

c2b842eb-fd1a-4479-8372-52c1ae74ee56

Mitchell, Eleanor J.

f7d8ce2d-e847-44c7-95af-4076be358af8

Wakefield, Natalie

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Knight, Marian

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Dorling, Jon

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Thornton, Jim G.

ac3af3ba-9b2e-4291-98d5-3618a853123f

Walker, Kate F.

6a8fc99a-eaed-4580-95af-bd8bc2f9f440

May 2022

Wyn Jones, Nia

c2b842eb-fd1a-4479-8372-52c1ae74ee56

Mitchell, Eleanor J.

f7d8ce2d-e847-44c7-95af-4076be358af8

Wakefield, Natalie

da1a6392-be93-4c43-9761-b7776f9bb1cf

Knight, Marian

85aa1323-352b-431c-8fd2-e4902f6e8dc0

Dorling, Jon

e55dcb9a-a798-41a1-8753-9e9ff8aab630

Thornton, Jim G.

ac3af3ba-9b2e-4291-98d5-3618a853123f

Walker, Kate F.

6a8fc99a-eaed-4580-95af-bd8bc2f9f440

Wyn Jones, Nia, Mitchell, Eleanor J., Wakefield, Natalie, Knight, Marian, Dorling, Jon, Thornton, Jim G. and Walker, Kate F. (2022) Impacted fetal head during second stage Caesarean birth: a prospective observational study. European Journal of Obstetrics, Gynecology and Reproductive Biology, 272, 77-81. (doi:10.1016/j.ejogrb.2022.03.004).

Record type: Article

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.

Methods: prospective observational study.

Main outcome measures: technique(s) used, maternal and neonatal outcomes.

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Accepted/In Press date: 1 March 2022

e-pub ahead of print date: 4 March 2022

Published date: May 2022

Additional Information: Funding Information: This project is funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (project reference 17/75/09). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funding body approved the final design of the study. The funding body had no involvement in the collection, analysis, and interpretation of data and in writing the manuscript. Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: NIHR HTA grant funding to support the submitted work, JD declares grants from NIHR, during the conduct of the study; grants from NIHR, from CIHR, from IWK, grants from Nova Scotia Research, outside the submitted work. All authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Publisher Copyright: © 2022 The Authors

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