Impacted Foetal Head

Question 1

Definition of impacted foetal head

Answer 1

The foetal head becomes lodged in the pelvis during labour making caesarean section challenging, necessitating additional manoeuvres or tocolysis for disimpaction and delivery

Question 2

Incidence of impacted foetal head

Answer 2

1.5% of all caesarean deliveries worldwide. 5% in the UK.

Question 3

Risk Factors of impacted foetal head

Answer 3

Maternal and foetal
- Primiparous
- No previous caesarean
- Gestation >37/40
- Epidural
- Oxytocin infusion
- Prolonged second stage
- Caput and moulding

Operative
- Junior surgeon
- Failure to progress
- Failed assisted vaginal delivery

Question 4

Complications of impacted foetal head

Answer 4

Maternal
- PPH
- Trauma and injury to the bladder, bowel, ureters
- Increased risk of blood transfusion

Neonatal
- Fracture and facial laceration
- Brachial plexus injury
- Low APGAR score
- NICU admission
- Death

Question 5

Management of impacted foetal head

Answer 5

• Identification of at-risk patients and clear communication
• Manoeuvres from below: Vaginal push, fetal pillow, flexion and abduction of maternal legs
• Manoeuvres from above: Reverse breech delivery, extension of uterine incision, Patwardhan delivery
• Anaesthetic manoeuvres: lower operating table, head down positioning, tocolysis (GTN, terbutaline)
  Prepare for PPH