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from Section 6 - Intrapartum/Delivery
Published online by Cambridge University Press: 08 April 2025
An impacted fetal head (IFH) occurs when the fetal head cannot be delivered by usual maneuvers during a cesarean delivery. It is estimated to occur during 16% of second-stage cesarean deliveries and complicates 1.5% of all births. It is associated with oxytocin augmentation, full cervical dilation, mid/low station, molding, and caput. The incidence may be increasing with the trend to allow patients to labor longer to increase vaginal delivery rates. Full dilation cesarean delivery is associated with intraoperative trauma, febrile morbidity, hemorrhage, an Apgar score of <3, and asphyxia. Intraoperative trauma and hemorrhage are a direct result of damage to a thinned lower uterine segment during the delivery of the fetal head. There are studies suggesting that uterine extensions and hemorrhage may be decreased with delivery via reverse breech extraction and the Patwhardan maneuver compared to push methods such as the hand from below. Strategies to decrease morbidity are discussed including individual and team actions and training.
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