CLINICAL PARADIGMS IN THE MANAGEMENT OF IMPACTED FOETAL HEAD DURING CAESAREAN DELIVERY: A COMPREHENSIVE ANALYSIS

Abstract

Caesarean section (CS) is the most critical operative intervention in obstetrics. As the frequency of CS increases, so does the incidence of procedures performed at full cervical dilatation. This scenario often leads to an impacted foetal head (IFH). IFH complicates approximately 1 in 10 emergency CS and up to 16% of second-stage deliveries. Unsuccessful attempts at instrumental vaginal delivery significantly elevate the risk, effectively doubling the chance of impaction as the head is wedged further into the pelvic cavity. The lack of space between the rigid maternal bony pelvis and the molded foetal skull makes hand insertion through the hysterotomy technically difficult. A refined lateral extra-uterine elevation method has been proposed to manage the situation. The procedure emphasizes the use of the extra-uterine pelvic space to avoid the tightest points of impaction.

The protocol begins with a horizontal superficial incision approximately 2–3 cm below the utero-vesical fold after displac- ing the bladder flap. The surgeon’s hand is maneuvered downwards between the lateral pelvic space. By utilizing the fact that the transverse diameter of the maternal pelvis is larger than the anteroposterior diameter, the surgeon can reach beneath the foetal head without exerting pressure against the maternal pubic bone. The operator then uses lightly fixed fingers to elevate the presenting part while squeezing the lower segment of the uterus against the foetus. This facilitates a steady upward movement. The extraction is only completed once the head has been lifted into the maternal abdomen and is free of the pelvic brim. This method offers the advantage of reduced trauma and infection risk. By emphasizing vacuum release through fluid swirl rather than mechanical devices, the technique offers a cost-effective alternative in resource-limited settings.