Managing an impacted fetal head at caesarean section: a UK survey of healthcare professionals and parents

Hanley, Stephanie; Walker, Kate F.; Wakefield, Natalie; Plachcinski, Rachel; Pallotti, Phoebe; Tempest, Nicola; Pillai, A.; Thornton, Jim; Jones, Nia; Mitchell, Eleanor

doi:10.1016/j.ejogrb.2022.01.033

Cited by 8 publications

(19 citation statements)

References 18 publications

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“…Our findings mirror recent surveys indicating that junior obstetricians may favor less technical strategies, such as tilting the operating table head down 14,30 . This study also shows a lack of familiarity with the Patwardhan technique, since only one trainee attempted to use it 14 .…”

Section: Discussionsupporting

confidence: 84%

“…This study suggests that more experienced obstetricians may Our findings mirror recent surveys indicating that junior obstetricians may favor less technical strategies, such as tilting the operating table head down. 14,30 This study also shows a lack of familiarity with the Patwardhan technique, since only one trainee attempted to use it. 14 Both "expert" and "novice" obstetricians experienced the most difficulty disimpacting the fetal mannequin in an occipito-anterior position.…”

Section: Ta B L E 2 Face and Content Validity Of Simulatormentioning

confidence: 87%

“…This study reveals inconsistent and potentially harmful approaches to vaginal disimpaction, even among senior midwives. This likely reflects an absence of training in the push method, despite evidence indicating that it is the most commonly employed technique used by UK practitioners 14,30 . To perform vaginal disimpaction safely and effectively, the accoucheur should use their whole hand to cup and flex the fetal head 11,29,31 .…”

Section: Discussionmentioning

confidence: 99%

“…This likely reflects an absence of training in the push method, despite evidence indicating that it is the most commonly employed technique used by UK practitioners. 14 , 30 To perform vaginal disimpaction safely and effectively, the accoucheur should use their whole hand to cup and flex the fetal head. 11 , 29 , 31 To achieve adequate vaginal access for disimpaction, the woman's legs should be re‐positioned in a semi‐lithotomy position.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study

Cornthwaite

Winter

Lenguerrand

et al. 2022

Acta Obstet Gynecol Scand

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Section: Discussionsupporting

confidence: 84%

Section: Ta B L E 2 Face and Content Validity Of Simulatormentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study

Cornthwaite

Winter

Lenguerrand

et al. 2022

Acta Obstet Gynecol Scand

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show abstract

“…The MIDAS study (Managing an Impacted fetal heaD At emergency caesarean Section) (NIHR HTA 17/75/09) examined the acceptability and feasibility of different techniques of managing impacted fetal head. This programme included a national survey of health professionals about current practice [ 9 ]; interviews with women about the acceptability of different techniques [ 10 ]; a Delphi survey to get consensus on which techniques should be prioritised and tested in an RCT; and the design of two possible RCTs of different techniques for managing impacted fetal head during emergency CS [ 11 ]. Before proceeding to a definitive RCT it is important to explore whether this is feasible and acceptable and which of the two RCT designs is preferred.…”

Section: Introductionmentioning

confidence: 99%

The acceptability and feasibility of a randomised trial exploring approaches to managing impacted fetal head during emergency caesarean section: a qualitative study

Romano

Ayers

Constantinou

et al. 2023

BMC Pregnancy Childbirth

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Background Caesarean sections (CS) account for 26% of all births in the UK, of which at least 5% are done at full dilatation, in the second stage of labour. Second stage CS may be complicated by the fetal head being deeply impacted in the maternal pelvis, requiring specialist skills to achieve a safe birth. Numerous techniques are used to manage impacted fetal head, however, there are no national clinical guidelines in the UK. Aim To explore health professionals’ and women’s views on the acceptability and feasibility of a randomised controlled trial (RCT) designed to explore approaches to managing an impacted fetal head during emergency CS. Methods Semi-structured interviews with 10 obstetricians and 16 women (6 pregnant and 10 who experienced an emergency second stage CS). Interviews were transcribed and analysed using systematic thematic analysis. Results The findings considered the time at which you obtain consent, how and when information about the RCT is presented, and barriers and facilitators to recruiting health professionals and women into the RCT. Obstetricians emphasised the importance of training in the techniques, as well as the potential conflict between the RCT protocol and current site or individual practices. Women said they would trust health professionals’ to use the most appropriate technique and abandon the RCT protocol if necessary. Similarly, obstetricians raised the tension between the RCT protocol versus safety in reverting to what they knew under emergency situations. Both groups reflected on how this might affect the authenticity of the results. A range of important maternal, infant and clinical outcomes were raised by women and obstetricians. However, there were varying views on which of the two RCT designs presented to participants would be preferred. Most participants thought the RCT would be feasible and acceptable. Conclusions This study suggests an RCT designed to evaluate different techniques for managing an impacted fetal head would be feasible and acceptable. However, it also identified a number of challenges that need to be considered when designing such an RCT. Results can be used to inform the design of RCTs in this area.

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Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study

Peled,

Muraca,

Ratner

et al. 2024

Intl J Gynecology & Obste

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ObjectiveSecond‐stage cesarean delivery (CD) is associated with subsequent preterm birth (PTB). It has been suggested that an increased risk of PTB after second‐stage cesarean delivery could be linked to a higher chance of cervical injury due to the extension of the uterine incision. Previous studies have shown that reverse breech extraction is associated with lower rates of uterine incision extensions compared to the “push” method.We aimed to investigate the association between the method of fetal extraction during second‐stage CD and the rate of spontaneous PTB (sPTB), as well as other maternal and neonatal outcomes during the subsequent pregnancy.MethodsThis was a multicenter retrospective cohort study. The study population included women in their first subsequent singleton delivery following a second‐stage CD between 2004 and 2021. The main exposure of interest was the method of fetal extraction in the index CD (“push” method vs. reverse breech extraction). The primary outcome of this study was sPTB <37 weeks in the subsequent pregnancy. Secondary outcomes were overall PTB, trial of labor, and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling.ResultsDuring the study period, 2969 index CD during second stage were performed, of those 583 met the inclusion criteria, of whom 234 (40.1%) had fetal extraction using the reverse breech extraction method, while 349 (59.9%) had the “push” method for extraction. In univariate analysis, women in those two groups had statistically similar rates of sPTB (3.7% vs. 3.0%; odds ratio [OR] 1.25, 95% CI: 0.49–3.19) and overall PTB (<37, <34 and <32 weeks), as well as other maternal, neonatal, and trial of labor outcomes. This was confirmed by multivariate analyses with an adjusted OR of 1.27 (95% CI: 0.43–3.71) for sPTB.ConclusionAmong women with a previous second‐stage CD, no significant difference was observed in PTB rates in the subsequent pregnancies following the “push” method compared to the reverse breech extraction method.

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Managing an impacted fetal head at caesarean section: a UK survey of healthcare professionals and parents

Cited by 8 publications

References 18 publications

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study

The acceptability and feasibility of a randomised trial exploring approaches to managing impacted fetal head during emergency caesarean section: a qualitative study

Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study

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