Impacted fetal head: A retrospective cohort study of emergency caesarean section

Katie Cornthwaite, Tim Draycott, Rachna Bahl, Emily Hotton, Cathy Winter, Erik Lenguerrand

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objective
To investigate risk factors, management and outcomes of impacted fetal head (IFH) at caesarean section (CS).

Study design
This is a retrospective cohort study of all women with singleton, cephalic pregnancies who had an emergency CS during one-year (2016) at North Bristol NHS Trust, UK (n = 838).

The incidence of caesarean section at full dilatation (CSFD) and IFH were calculated using the annual birth rate. To identify risk factors for IFH, maternal, perinatal and intrapartum characteristics were compared according to the presence or absence of IFH, and separately for first- and second-stage CS. Techniques employed to disimpact the fetal head were described. Univariable and multivariable comparisons of maternal and perinatal outcomes were made between cases with and without an IFH. Characteristics and outcomes were compared using modified Poisson regression.

Results
CSFD accounted for 2.1 % of all births. IFH complicated 1.5 % of all births (11.3 % of emergency CS), with 55.8 % occurring prior to full cervical dilatation.

Increased rates of IFH at CS were associated with: oxytocin augmentation (RR = 2.47 [1.61–3.80]), full cervical dilatation (RR = 4.24 [2.96–6.07], mid/low station (RR = 4.14 [2.72–6.32]), moulding (RR = 4.39 [2.55–7.54]) and caput (RR = 6.60 [3.09–14.10]). Junior operators documented IFH more than consultants (RR = 9.61 [1.35–68.2]).

The strategies recorded for managing IFH included: tocolysis, reverse breech extraction and vaginal push up (33.7 %, 14.7 % and 11.6 % cases respectively) with two or more techniques used in 21.1 % cases.

IFH at CS was independently associated with an increased risk of uterine extensions (RR = 3.09 [1.96–4.87]) and a composite adverse perinatal outcome (RR = 1.66 [1.21–2.28]).

Conclusions
IFH is a common and heterogeneous complication associated with increased complications for both mother and baby, independent of those of CSFD. Obstetricians must remain vigilant to the possibility of IFH at all emergency CS, particularly those at full cervical dilatation or with evidence of obstructed labour. There is an urgent need for a standardised management algorithm and training in evidence-based disimpaction techniques.
Original languageEnglish
Pages (from-to)85-91
Number of pages7
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume261
Early online date21 Apr 2021
DOIs
Publication statusPublished - 1 Jun 2021

Bibliographical note

Publisher Copyright:
© 2021

Keywords

  • impacted fetal head
  • Caesarean section
  • cohort

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