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Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument

^1. Southend Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK
^2. Basildon University Hospital NHS Foundation Trust, Nethermayne, Basildon, Essex SS16 5NL, UK Email: rvarma99{at}aol.com (corresponding author)

Key content:

• There has been a disproportionate increase in caesarean section performed in the second stage of labour in the last few years.
  
• Difficult delivery of the fetal head during caesarean section carries a higher risk of complications for both mother and baby.
  
• The National Sentinel Caesarean Section Audit Report, published by the Royal College of Obstetricians and Gynaecologists recommends a consultant presence when caesarean section is performed at full dilatation.
  

Learning objectives:

• The obstetrician needs to anticipate the possibility of difficult delivery of the fetal head during caesarean section.
  
• Using an assistant to push the fetus can cause trauma, as the force required to push is uncontrolled.
  
• The Foetal Disimpacting System® seems to be effective in elevating the fetal head when it is deeply engaged.
  

Ethical issues:

• There is a need for more data before the fetal disimpacting device is adopted in routine obstetric practice.
  
• Use of this device when preparing for an emergency caesarean section, for instance in a situation of umbilical cord prolapse, may be justified.
  

Please cite this article as: Singh M, Varma R. Reducing complications associated with a deeply engaged head at caesarean section: a simple instrument. The Obstetrician & Gynaecologist 2008;10:38–41.

Keywords caesarean section / deeply engaged head / delivery complications / failed instrumental delivery / fetal disimpacting device