Our Summary

During a C-section, sometimes the baby’s head can get stuck in the mother’s pelic region, a problem known as an ‘impacted fetal head’. This happens in about 16% of C-sections during the second stage of labor. There are different techniques to handle this situation, but it’s not clear which one is the best for the mother and baby.

This research looked through past studies to figure out which technique is best. The researchers excluded any studies that didn’t directly compare two methods or didn’t fit their criteria. They focused on six key outcomes: the need for a larger uterine incision, blood transfusion, bladder injury, bleeding after birth, newborns needing to go to the NICU, and a low Apgar score (a measure of the baby’s health) at 5 minutes.

They looked at 16 studies involving 3,344 women. 13 studies compared the “push” method (where the doctor pushes the baby up and out) with “reverse breech extraction” (where the doctor pulls the baby out by the feet). The data showed that the push method had higher risks for all six outcomes compared to reverse breech extraction.

Three studies compared the push method with Patwardhan’s technique, another method of birth. There was no significant difference in the outcomes between these two methods.

Based on these studies, it seems that reverse breech extraction might be better than the push method. However, we still can’t definitively say which method is best because not all methods have been thoroughly tested. More well-designed studies are needed to give a clearer answer on how to best manage this issue.

FAQs

  1. What is an ‘impacted fetal head’ during a C-section?
  2. What are the six key outcomes the researchers focused on in the study?
  3. What were the findings of the study regarding the “push” method and the “reverse breech extraction” method during a C-section?

Doctor’s Tip

The doctor may advise the patient that if they experience an impacted fetal head during a C-section, the reverse breech extraction technique may be preferred over the push method. However, it’s important to discuss all options with your healthcare provider and make an informed decision based on your individual circumstances. It’s also important to keep in mind that further research is needed to fully understand the best approach for managing this situation.

Suitable For

Overall, patients who may be recommended for a cesarean section include those with certain medical conditions that could make vaginal delivery risky, such as placenta previa, active genital herpes, or certain heart conditions. Other factors that may lead to a recommendation for a C-section include multiple pregnancies (such as twins or triplets), fetal distress, or a baby in the breech position. Ultimately, the decision to have a cesarean section should be made by the healthcare provider in consultation with the patient, taking into consideration the individual circumstances and risks involved.

Timeline

Before a cesarean section, a patient may experience labor contractions, fetal distress, or other complications that require surgical intervention. The decision to perform a C-section is made by the healthcare provider based on the mother and baby’s health and safety.

During the C-section procedure, the patient will be given anesthesia, either spinal or epidural, to numb the lower part of their body. The healthcare team will make an incision in the abdomen and uterus to deliver the baby. The procedure typically takes about 45 minutes to an hour.

After the C-section, the patient will be monitored closely for any complications such as infection, bleeding, or blood clots. They may also experience pain and discomfort at the incision site. The healthcare team will provide pain medication and support to help the patient recover.

Overall, the patient’s recovery time after a C-section may be longer than after a vaginal delivery, and they may need extra support and care in the days and weeks following the procedure. It is important for the patient to follow their healthcare provider’s instructions for post-operative care to ensure a smooth recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cesarean section and the possibility of impacted fetal head include:

  1. What is the likelihood of my baby’s head getting stuck during a C-section?
  2. What are the potential risks and complications associated with an impacted fetal head?
  3. How do you typically handle a situation where the baby’s head is stuck during a C-section?
  4. Are there different techniques for managing an impacted fetal head, and if so, what are they?
  5. What are the potential benefits and drawbacks of each technique?
  6. How will you determine which technique to use during my C-section?
  7. What is the recovery process like after a C-section with an impacted fetal head?
  8. Are there any long-term effects for me or my baby if the baby’s head is stuck during the C-section?
  9. Are there any specific precautions or steps I should take before my C-section to reduce the risk of an impacted fetal head?
  10. Are there any additional resources or information you can provide me with about this issue?

Reference

Authors: Gq Peak A, Barwise E, Walker KF. Journal: Eur J Obstet Gynecol Reprod Biol. 2023 Feb;281:12-22. doi: 10.1016/j.ejogrb.2022.12.017. Epub 2022 Dec 12. PMID: 36525940