Difficult caesarean delivery of an impacted head and neonatal skull fracture: Can the morbidity be avoided?

Tan, Eelin

doi:10.1080/01443610701325861

Cited by 16 publications

(24 citation statements)

References 8 publications

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“…31 On the other hand, our estimates of the adverse effects of midcavity operative vaginal delivery may have been underestimated as some caesarean deliveries in the second stage of labour would have been carried out with the fetal head below midcavity station. 32,33 Further limitations of our data source included the absence of information on the use of rotational forceps and missing information on a significant fraction of subjects for variables such as prepregnancy weight and position of the fetal head, which was addressed using multiple imputation. We were also unable to assess long-term effects of caesarean delivery and midcavity operative vaginal delivery.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery

Muraca

Skoll

Lisonkova

et al. 2017

BJOG

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ObjectiveTo quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery.DesignPopulation‐based, retrospective cohort study.SettingBritish Columbia, Canada.PopulationTerm, singleton deliveries (2004–2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (n = 10 901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress).MethodsMultinomial propensity scores and mulitvariable log‐binomial regression models were used to estimate adjusted rate ratios (ARR) and 95% confidence intervals (95% CI).Main outcome measuresComposite severe perinatal morbidity/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications).ResultsAmong deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46–3.07; vacuum ARR 2.71, 95% CI 1.49–3.15; sequential ARR 4.68, 95% CI 3.33–6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05–2.36; vacuum ARR 2.29, 95% CI 1.57–3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum (ARR 1.28, 95% CI 1.04–1.61) and in severe maternal morbidity following attempted midcavity forceps delivery (ARR 2.34, 95% CI 1.54–3.56).ConclusionAttempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity/mortality and severe maternal morbidity, though these effects differ by indication and instrument.Tweetable abstractPerinatal and maternal morbidity is increased following midcavity operative vaginal delivery.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery

Muraca

Skoll

Lisonkova

et al. 2017

BJOG

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“…There are a number of widely accepted techniques that help obstetricians when faced with this potentially difficult task (Fasubaa et al 2002;Menticoglou et al 2007;Fong and Arulkumaran 1997;Levy et al 2005;Tan 2007). The most commonly used techniques are the push technique and the pull method (Figures 1 and 2) (see Appendix 1 for variations).…”

Section: Introductionmentioning

confidence: 99%

Delivery of the deeply engaged head: a lacuna in training

Sethuram

Jamjute

Kevelighan

2010

Journal of Obstetrics and Gynaecology

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The percentage of second stage caesarean sections is on the rise. The delivery of a deeply engaged head in the second stage by caesarean section is an experience feared by most junior registrars. Among the different delivery techniques described, the pull technique has been proven to have a lesser morbidity than the push technique. However, trainees do not receive any structured training in either of these methods. We undertook a survey among 150 UK trainees in SPROGS 2008 in order to understand their experience in dealing with a deeply engaged head in second stage by CS, to ascertain whether trainees feel that they need training to deal with the situation and to discover the means by which this training can be delivered. The questionnaire return rate was 94%. More than 80% agreed that they had faced difficulties in the past while trying to deliver a deeply engaged head. Only 20% used the recommended semi-lithotomy position during caesarean section for an impacted head. Among the trainees who had received only UK training, only 42% were confident of doing a pull method if the need arose. More than 80% of the trainees agreed that supervised sessions to teach alternative techniques for delivery, such as the reverse breech/pull method would be useful and that it would improve their confidence when doing a trial of vaginal delivery. The RCOG agreed that there is little formal training in delivery of a deeply engaged head and is considering recommending trainees complete 2 OSATS (Objective Structured Assessment Tools) in this area. It has also asked the authors to form a skills and drills protocol, which the authors have done and submitted to the RCOG.

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“…This bias was unavoidable given the unblinded design of this feasibility study. In at least one previous case report, the use of a vaginal assistant has been associated with fetal skull fracture at 0 station [6.] For this reason, any intervention preventing the use of a vaginal assistant may have important clinical implications.…”

Section: Commentmentioning

confidence: 99%

“…An engaged head may require additional procedures, such as elevation of the head by an assistant's hand placed in the vagina or by reverse breech delivery through the hysterotomy incision [5,6,7,8]. Cesarean delivery for arrest of descent has been associated with fetal depressed skull fracture [5,6] and, more commonly, maternal injuries to the uterus, cervix and upper vagina [7,8]. During arrest of descent, maternal tissues conform to the fetal head, resulting in a suction-cup like effect during cesarean delivery.…”

Section: Introductionmentioning

confidence: 99%

A Simple Device Prevents Hysterotomy Extensions during Cesarean Delivery for Failed Second Stage of Labor

Barrier

Allison

Andelin

et al. 2013

Gynecol Obstet Invest

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Background/ Aims: During arrest of descent, maternal tissues conform to the fetal head, resulting in a suction-cup like effect during cesarean delivery. We hypothesize that breaking this suction might ease delivery. A novel device was designed for this purpose and tested in this series of 23 patients. Methods: University-based retrospective cohort feasibility study. Term pregnant women with second-stage labor arrest (n = 23) provided written consent for use of the experimental device, inserted vaginally prior to cesarean delivery. Delivering obstetricians rated device effectiveness. Following case collection, the presence of hysterotomy extensions in study patients was retrospectively compared with controls (n = 49) from the same study period. Results: On a 7-point Likert scale, consultant obstetricians rated overall device effectiveness as 6.0, and resident obstetricians rated it 6.3, consistent with a moderate improvement in ease of delivery. The device performed optimally at mid-pelvic stations (0 to +1), with no hysterotomy extensions (n = 0/17), which was significantly better than controls (n = 14/41, 34%, p < 0.01). Conclusion: A simple device prevented hysterotomy extension during second-stage cesarean delivery at 0 and +1 station. Obstetricians perceived that the device afforded a moderate improvement in delivery compared with previous deliveries in which the device was not used.

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Difficult caesarean delivery of an impacted head and neonatal skull fracture: Can the morbidity be avoided?

Cited by 16 publications

References 8 publications

Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery

Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery

Delivery of the deeply engaged head: a lacuna in training

A Simple Device Prevents Hysterotomy Extensions during Cesarean Delivery for Failed Second Stage of Labor

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