A case–control study about foetal trauma during caesarean delivery

Dolivet, Enora; Delesalle, C.; Morello, R.; Blouet, Marie; Bronfen, C.; Dreyfus, Michel; Benoist, G.

doi:10.1016/j.jogoh.2018.05.002

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…A 2017 survey of midwives at a tertiary maternity unit in the UK, reported that half of midwives surveyed would insert two fingers, as with vaginal examination, to apply pressure to the fetal head. 47 Some case reports, 48 case series 41,49 and coronial inquiries 25 have suggested an association between the vaginal push technique and perinatal skull fracture although the precise mechanism of injury is unclear. It is axiomatic that pushing up on the fetal head with one or two fingers might increase the risk of fetal trauma, however this does not explain the most common parietal fractures that cannot be related to direct pressure by fingers.…”

Section: Vaginal Disimpactionmentioning

confidence: 99%

RETRACTED: Management of Impacted Fetal Head at Caesarean Birth

Cornthwaite¹,

Bahl²,

Winter³

et al. 2023

BJOG

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Plain language summaryOver one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby’s head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby’s head may result – this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications.Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH.When an IFH occurs, the maternity team can use different approaches to help deliver the baby’s head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby’s head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances.This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance.

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Section: Vaginal Disimpactionmentioning

confidence: 99%

RETRACTED: Management of Impacted Fetal Head at Caesarean Birth

Cornthwaite¹,

Bahl²,

Winter³

et al. 2023

BJOG

View full text Add to dashboard Cite

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“…[14,15] Dolivet et al identified ten newborns with at least one fracture out of 7930 C-sections (1.26%); in two cases of these ten, there was a fracture of the humerus. [3] The femur fractures are usually caused by undue traction, poor delivery technique, small uterine incision, and inadequate relaxation especially in case of fetal macrosomia. Furthermore, these injuries can also happen when the breech is well engaged in the pelvis or when a footling has descended into the vagina.…”

Section: Resultsmentioning

confidence: 99%

“…[1] Injuries at birth during delivery are rare and account today for 1% of all births in the world. [3] However, it can be the most common cause of morbidity and mortality. Most publications concerning neonatal injuries are mostly on the baby's head, neck, and shoulders injury.…”

Section: Introductionmentioning

confidence: 99%

Unusual obstetric trauma in newborn

et al. 2020

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Background: Birth injuries during delivery are rare but can be the most common cause of morbidity and mortality. All parts of the body can be damaged. The aim of this study is to determine the impact of these uncommon injuries on the newborn. This is a retrospective chart review of 11 newborn babies who had concurrent birth trauma. Pertinent data on the cause of injury treatment and the outcome were recorded. Methods: It is a retrospective chart review of newborns who sustained a birth trauma during delivery. These patients presented to the Department of Pediatric Surgery, SETIF, Algeria from 2010 to 2020. Results: A total of 11 cases with birth trauma occurred during delivery were managed during the study tenure. Of these 11, 9 were males and 2 females. Two cases sustained scalp laceration including one extensive laceration exposing the brain tissue with uncontrollable hemorrhage. One newborn sustained facial trauma secondary to the forceps delivery. One newborn who needed resuscitation and ventilation at birth developed bilateral pneumothorax secondary to the barotrauma. One patient sustained a femur fracture whereas another had a humerus fracture along with brachial plexus injury during delivery. Three cases had umbilical cord injury including two cases of clamped hernia of the umbilical cord resulting in neonatal intestinal obstruction. Two cases had scrotal trauma including one with testicular evisceration. Two cases were expired in this cohort. Conclusion: We have presented a diversity of birth trauma in newborns and their management. Proper antenatal follow-up and better planning for the delivery can avoid such injuries in newborns which often require surgical interventions for the management and at times can lead to mortality as well.

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“…Safe and effective vaginal disimpaction depends on skill, knowledge and manual dexterity, but does not appear to be consistently or routinely taught, 18 with more than 80% of midwives reporting lack of training. There was evidence of uncertainty and anxiety among midwives about vaginal disimpaction, possibly related to reports attributing neonatal injury to vaginal disimpaction 8,29 . Consultants (who are more likely to be expert) are not always present or available during an IFH.…”

Section: Discussionmentioning

confidence: 99%

Definition, management, and training in impacted fetal head at cesarean birth: a national survey of maternity professionals

Cornthwaite

Hewitt

Scheer

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionThis study assessed views, understanding and current practices of maternity professionals in relation to impacted fetal head at cesarean birth, with the aim of informing a standardized definition, clinical management approaches and training.Material and methodsWe conducted a survey consultation including the range of maternity professionals who attend emergency cesarean births in the UK. Thiscovery, an online research and development platform, was used to ask closed‐ended and free‐text questions. Simple descriptive analysis was undertaken for closed‐ended responses, and content analysis for categorization and counting of free‐text responses. Main outcome measures included the count and percentage of participants selecting predefined options on clinical definition, multi‐professional team approach, communication, clinical management and training.ResultsIn total, 419 professionals took part, including 144 midwives, 216 obstetricians and 59 other clinicians (eg anesthetists). We found high levels of agreement on the components of an impacted fetal head definition (79% of obstetricians) and the need for use of a multi‐professional approach to management (95% of all participants). Over 70% of obstetricians deemed nine techniques acceptable for management of impacted fetal head, but some obstetricians also considered potentially unsafe practices appropriate. Access to professional training in management of impacted fetal head was highly variable, with over 80% of midwives reporting no training in vaginal disimpaction.ConclusionsThese findings demonstrate agreement on the components of a standardized definition for impacted fetal head, and a need and appetite for multi‐professional training. These findings can inform a program of work to improve care, including use of structured management algorithms and simulation‐based multi‐professional training.

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A case–control study about foetal trauma during caesarean delivery

Cited by 8 publications

References 15 publications

RETRACTED: Management of Impacted Fetal Head at Caesarean Birth

RETRACTED: Management of Impacted Fetal Head at Caesarean Birth

Unusual obstetric trauma in newborn

Definition, management, and training in impacted fetal head at cesarean birth: a national survey of maternity professionals

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