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

Cornthwaite, Katie; Hewitt, Pauline; Scheer, Jan W van der; Brown, Ian; Burt, Jenni; Dufresne, Eliane; Dixon‐Woods, Mary; Bahl, Rachna

doi:10.1111/aogs.14600

Cited by 4 publications

(30 citation statements)

References 40 publications

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“…c o m . u a REVIEWS ISSN 2786-6009 UKRAINIAN JOURNAL HEALTH OF WOMAN 2(171)/2024 13 черепа, крововилив у мозок, гіпоксичне ураження мозку, рідко -перинатальна смерть [5].…”

Section: вступunclassified

“…У світі персонал пологових будинків все частіше стикається з цією невідкладною ситуацією, а дослідження, проведені у Великій Британії, свідчать, що низьке розташування голівки плода може ускладнювати 1 із 10 екстрених пологів шляхом кесаревого розтину (КР). Крім того, різко зросла кількість повідомлень про перинатальні черепно-мозкові травми, пов'язані зі здавлюванням голівки плода під час вилучення при КР [4,5,16].…”

Section: вступunclassified

“…Підвищується ризик низького розташування голівки за низького положення плода, стимуляції окситоцином і/або за наявності ознак обструктивних пологів [4]. Неправильне положення плода і головно-тазова диспропорція також можуть підвищувати ризики [5]. Однак неможливо достовірно передбачити виникнення цього ускладнення в підготовці до КР, тому лікарі-акушери-гінекологи повинні бути готові до виникнення такого ускладнення в разі будь-якого ургентного КР.…”

Section: визначення поширеність фактори ризикуunclassified

“…Низьке розташування голівки плода може призводити до нестачі простору між голівкою плода та лобковим симфізом матері, що ускладнює можливість опуститися нижче за голівку плода, щоб її вивести. Такі труднощі в поєднанні з розтягненим і набряклим нижнім сегментом матки підвищують ризик ненавмисного подовження розрізу матки до бокових стінок з ураженням судинного пучка «розрив нижнього сегмента матки», формуванням гематом таза, пошкодженнями сечового міхура і сечоводів та віддаленими наслідками для жінок за майбутньої вагітності [5]. Спроба «народження» голівки під час скорочення матки може ще більше загострювати проблему виведення голівки до маткового розрізу [5].…”

Section: ускладнення для матері й плода під час виконання кр за низьк...unclassified

“…Ускладненні пологи можуть відстрочити народження вже скомпрометованого плода, що посилить розвиток гіпоксично-ішемічної енцефалопатії [5]. Надмірна сила під час можливої спроби декомпресії голівки плода може спричиняти родову травму, наприклад, перелом черепа і внутрішньочерепну кровотечу, які можуть потенційно призводити до тяжкої неонатальної захворюваності з інвалідизацією, і рідко -перинатальною смертю [5].…”

Section: ускладнення для матері й плода під час виконання кр за низьк...unclassified

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Impacted fetal head during caesarean section: prevalence, risk factors, methods of prevention and management (literature review)

Petrenko,

Pampukha

2024

UJHW

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Under certain circumstances, the fetal head may stop descending into the vagina during the second stage of labor, having its largest circumference into the pelvic cavity, while conservative methods of treatment may not be effective, and the clinical situation may require an emergency cesarean section with a "the deeply impacted fetal head" in the pelvic cavity. This is a technically complex method of delivery in this clinical situation, associated with serious risks for both the woman and the child. There are a number of approaches to prevent these complications and techniques for removing the fetus in this situation, however, there is currently no consensus on which of these approaches is best for this type of cesarean section. The aim - to investigate the main current data on possible techniques for fetal extraction with impacted fetal head during cesarean section and to compare their safety and effectiveness. A review of the literature on the definition of the concept of «impacted fetal head» during cesarean section, the distribution and risk factors of this complication, the study of possible complications for the mother and the fetus, techniques for preventing the occurrence of this condition, methods of removing the fetus with impacted head during cesarean section, as well as promising management methods. A comprehensive study of this obstetric emergency remains relevant for modern science, because it requires special techniques and skills of an obstetrician-gynecologist to prevent injuries to the mother and child, bleeding and other life-threatening conditions. There is a need to standardize the definition of terminology, improve the skills of doctors through simulation training and conduct large randomised trials to determine the best approaches and provide highly skilled care to mothers and children in situations that can potentially result in severe trauma. No conflict of interests was declared by the authors.

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Section: вступunclassified

Section: визначення поширеність фактори ризикуunclassified

Section: ускладнення для матері й плода під час виконання кр за низьк...unclassified

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Impacted fetal head during caesarean section: prevalence, risk factors, methods of prevention and management (literature review)

Petrenko,

Pampukha

2024

UJHW

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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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Management of impacted fetal head at cesarean birth: A systematic review and meta‐analysis

Cornthwaite,

van der Scheer,

Kelly

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionDespite increasing incidence of impacted fetal head at cesarean birth and associated injury, it is unclear which techniques are most effective for prevention and management. A high quality evidence review in accordance with international reporting standards is currently lacking. To address this gap, we aimed to identify, assess, and synthesize studies comparing techniques to prevent or manage impacted fetal head at cesarean birth prior to or at full cervical dilatation.Material and MethodsWe searched MEDLINE, Emcare, Embase and Cochrane databases up to 1 January 2023 (PROSPERO: CRD420212750016). Included were randomized controlled trials (any size) and non‐randomized comparative studies (n ≥ 30 in each arm) comparing techniques or adjunctive measures to prevent or manage impacted fetal head at cesarean birth. Following screening and data extraction, we assessed risk of bias for individual studies using RoB2 and ROBINS‐I, and certainty of evidence using GRADE. We synthesized data using meta‐analysis where appropriate, including sensitivity analyses excluding data published in potential predatory journals or at risk of retraction.ResultsWe identified 24 eligible studies (11 randomized and 13 non‐randomized) including 3558 women, that compared vaginal disimpaction, reverse breech extraction, the Patwardhan method and/or the Fetal Pillow®. GRADE certainty of evidence was low or very low for all 96 outcomes across seven reported comparisons. Pooled analysis mostly showed no or equivocal differences in outcomes across comparisons of techniques. Although some maternal outcomes suggested differences between techniques (e.g., risk ratio of 3.41 [95% CI: 2.50–4.66] for uterine incision extension with vaginal disimpaction vs. reverse breech extraction), these were based on unreliable pooled estimates given very low GRADE certainty and, in some cases, additional risk of bias introduced by data published in potential predatory journals or at risk of retraction.ConclusionsThe current weaknesses in the evidence base mean that no firm recommendations can be made about the superiority of any one impacted fetal head technique over another, indicating that high quality training is needed across the range of techniques. Future studies to improve the evidence base are urgently required, using a standard definition of impacted fetal head, agreed maternal and neonatal outcome sets for impacted fetal head, and internationally recommended reporting standards.

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

Cited by 4 publications

References 40 publications

Impacted fetal head during caesarean section: prevalence, risk factors, methods of prevention and management (literature review)

Impacted fetal head during caesarean section: prevalence, risk factors, methods of prevention and management (literature review)

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

Management of impacted fetal head at cesarean birth: A systematic review and meta‐analysis

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