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

• Published in: European journal of obstetrics & gynecology and reproductive biology 2022-04, Vol.271, p.88-92
• Main Authors: Hanley, Stephanie J., Walker, Kate F., Wakefield, Natalie, Plachcinski, Rachel, Pallotti, Phoebe, Tempest, Nicola, Pillai, Arani, Thornton, Jim, Jones, Nia, Mitchell, Eleanor J.
• Format: Article
• Language: English
• Subjects: Emergency caesarean section; Full dilatation; Impacted fetal head; Randomised controlled trial; Second stage
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2022.01.033

To understand current practice, expertise and training requirements for management of an impacted fetal head (IFH) at caesarean section (CS) in the UK, and whether a clinical trial of techniques to manage an IFH is acceptable. Five hundred and thirty-eight online surveys were completed by obstetricians (n = 206), obstetric anaesthetists (n = 38), midwives (n = 35) and parents (n = 259). Data was collected on incidences of CS and IFH, current use of techniques, and acceptability of a clinical trial to manage an IFH from health care professionals. Information on incidences of CS and recollection of an IFH, acceptability of techniques, and likelihood of taking part in a clinical trial were sought from parents. The most common technique used by obstetricians (84%) and midwives (69%) was the ‘push technique’. Eighty-seven percent of health care professionals would be willing to participate in a clinical trial, with 89% confirming that results would guide their clinical practice. Most parents expressed reluctance regarding participation in a clinical trial during labour (62%), due to preferring a doctor to adopt the technique they felt most comfortable with (63%). Given the lack of national guidance on appropriate techniques, no formal training, and no consensus on best practice for the management of an IFH during emergency CS, it is perhaps not surprising that the majority of heath care professionals would be willing to participate in a clinical trial, where results will guide their clinical practice. The future development of clinical trials, involving relevant stakeholders in the design of such trials, is crucial to improve upon the guidance and training provided to staff who may encounter an IFH.