RETRACTED: Management of Impacted Fetal Head at Caesarean Birth

Cornthwaite, Katie; Bahl, Rachna; Winter, Cathy; Wright, Alison; Kingdom, John; Walker, Kate F.; Tydeman, Graham; Briley, Annette; Schmidt‐Hansen, Mia

doi:10.1111/1471-0528.17534

Cited by 8 publications

(2 citation statements)

References 88 publications

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“…(4) An impacted fetal head is estimated to complicate one in ten unplanned CDs and is associated with low-segment uterine incision extensions. There are several techniques to assist the delivery of a baby with an impacted head, and these include an assistant applying pressure to reposition the baby's head from the vaginal canal, delivering the baby in a feet-first position, employing a specifically designed inflatable balloon device to raise the baby's head, and/or administering medication to relax the womb [23]. There is no consensus on which maneuver is best for reducing complications, yet documenting the technique used could have contributed to our knowledge regarding the association between the maneuver used and unintended low-segment uterine extensions.…”

Section: Referencementioning

confidence: 99%

Cesarean Uterine Lacerations and Prematurity in the Following Delivery: A Retrospective Longitudinal Follow-Up Cohort Study

Reichman,

Hirsch,

Fridman

et al. 2024

JCM

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(1) Background: We aimed to investigate whether second-stage cesarean delivery (SSCD) had a higher occurrence of low-segment uterine incision extensions compared with cesarean delivery (CD) at other stages of labor and to study the association of these extensions with preterm birth (PTB). (2) Methods: In this retrospective longitudinal follow-up cohort study, spanning from 2006 to 2019, all selected mothers who delivered by CD at first birth (P1) and returned for second birth (P2) were grouped by cesarean stage at P1: planned CD, first-stage CD, or SSCD. Mothers with a PTB at P1, multiple-gestation pregnancies in either P1 or P2 and those with prior abortions were excluded. (3) Results: The study included 1574 selected women who underwent a planned CD at P1 (n = 483 (30.7%)), first-stage CD (n = 878 (55.8%), and SSCD (n = 213 (13.5%)). There was a higher occurrence of low-segment uterine incision extensions among SSCD patients compared to first-stage CDs and planned CDs: 50/213 (23%), 56/878 (6.4%), and 5/483 (1%), respectively (p < 0.001). A multivariate logistic regression showed that women undergoing an SSCD are at risk for low-segment uterine incision extensions compared with women undergoing a planned CD, OR 28.8 (CI 11.2; 74.4). We observed no association between the occurrence of a low-segment uterine incisional extension at P1 and PTB ≤ 37 gestational weeks in the subsequent delivery, with rates of 6.3% (7/111) for those with an extension compared to 4.5% (67/1463) for those without an extension (p = 0.41). Notably, parturients experiencing a low-segment uterine incisional extension during their first childbirth were six times more likely to have a preterm delivery before 32 weeks of gestation compared to those without extensions, with two cases (1.8%) compared to four cases (0.3%), respectively. A similar trend was observed for preterm deliveries between 32 and 34 weeks of gestation, with those having extensions showing twice the prevalence of prematurity compared to those without, with a p-value of 0.047. (4) Conclusions: This study highlights that mothers undergoing SSCD experience higher prevalence of low uterine incision extensions compared to other CDs. To further ascertain whether the presence of these extensions is associated with preterm birth (PTB) in subsequent births, particularly early PTB before 34 weeks of gestation, larger-scale future studies are warranted.

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Section: Referencementioning

confidence: 99%

Cesarean Uterine Lacerations and Prematurity in the Following Delivery: A Retrospective Longitudinal Follow-Up Cohort Study

Reichman,

Hirsch,

Fridman

et al. 2024

JCM

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“…Delivery of the impacted foetal head at full dilatation caesarean section can be technically challenging and can pose significant risks to the mother and baby, including brain injury, and is a common cause of litigation [1]. A deeply impacted foetal head can be encountered at 16% of full dilatation caesarean sections [2].…”

Section: Introductionmentioning

confidence: 99%

Two Cases of Posterior Uterine Rupture After Foetal Pillow Use; Is It Time To Think Twice About Using the Foetal Pillow?

Magro

2023

J Gynecol Clin Obstet Reprod Med.

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Introduction: The incidence of caesarean section at full dilatation is increasing, with 10% being emergency cases. The Fetal Pillow device helps elevate the foetal head during such caesarean sections, potentially reducing blood loss and neonatal complications, however the evidence for this has recently been called into question. The authors presented 2 cases of possible complications associated with fetal pillow use. Case 1: A 40-year-old woman with a history of one previous caesarean section opted for vaginal birth after caesarean. After induced labor, the patient experienced fetal distress during pushing, leading to an emergency caesarean section using a Fetal Pillow. During the surgery, a 10cm vertical full-thickness posterior uterine wall rupture was noted, but the baby was delivered safely. The woman recovered well, but in future pregnancies, the patient was advised to have a planned caesarean section at 37 weeks. Case 2: A 36-year-old woman with two previous vaginal deliveries presented in spontaneous labor and ruptured membranes. An emergency caesarean section using a Fetal Pillow was performed due to a delay in the second stage of labour. Intraoperatively a 6cm vertical partial thickness posterior wall dehiscence was noted. The patient delivered a healthy baby boy with an uneventful recovery and was advised for a planned caesarean section in future pregnancies. Discussion: Posterior uterine wall ruptures are very rare but known to occur in labour. The authors reported the first 2 cases in the literature following Fetal Pillow use, raising the question as to whether the Fetal Pillow had any role in causing this rare uterine injury. Evidence on the efficacy and safety of Fetal Pillow remains limited and recent concerns have led to a recall of a significant study. These complications should be reported to ensure patient safety and regulatory awareness. Conclusion: This report presents two cases of posterior uterine wall rupture following the use of Fetal Pillow. It calls for a larger, well run, randomized control trial to analyze the safety of Fetal Pillow use and suggests that all Obstetricians should be educated on alternative strategies for foetal head disimpaction during cesarean sections.

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