From the Guidelines
Prevention of fetal head impaction is crucial and can be achieved through techniques such as manual vaginal disimpaction and the use of a fetal pillow, as outlined in the American Journal of Obstetrics and Gynecology 1.
Key Techniques
- Manual vaginal disimpaction: introducing a hand into the vagina to move the fetal head up into the abdomen before making a uterine incision, reducing the likelihood of an impacted fetal head 1.
- Fetal Pillow: using an inflatable device in the vagina to move the fetal head up into the abdomen before making a uterine incision, also reducing the likelihood of an impacted fetal head 1. These methods are specifically designed to prevent fetal head impaction during cesarean delivery, highlighting the importance of proactive measures to ensure a safe delivery process.
From the FDA Drug Label
Except in unusual circumstances, oxytocin should not be administered in the following conditions: ... borderline cephalopelvic disproportion... The answer is: proper administration of oxytocin and careful patient selection, including avoiding its use in patients with borderline cephalopelvic disproportion, can help prevent fetal head impaction. 2
- Key factors to consider include:
- careful patient selection
- proper administration of oxytocin
- avoiding use in patients with conditions that may increase the risk of fetal head impaction, such as borderline cephalopelvic disproportion.
From the Research
Prevention of Fetal Head Impaction
To prevent fetal head impaction, several factors and techniques can be considered:
- Avoiding advanced cervical dilatation, as it is a risk factor for impacted fetal head 3, 4, 5
- Minimizing the use of oxytocin augmentation, which can increase the risk of fetal head impaction 3, 4
- Avoiding prolonged second stage of labor, as it can lead to fetal head impaction 3, 4
- Using prophylactic manual rotation of occiput posterior and transverse positions to decrease operative delivery, as shown in the PROPOP randomized clinical trial 6
- Considering the use of techniques such as lowering the height of the operating table, placing the patient in the head down position, and providing pharmacological tocolysis to facilitate delivery 3, 4
Techniques to Facilitate Delivery
In cases where fetal head impaction occurs, several techniques can be used to facilitate delivery:
- Pushing the head through the vagina or pulling the infant's feet through the uterine incision, with the pulling method potentially having better outcomes 7
- Using uterine relaxation, patient positioning, and special attention to the uterine incision to minimize complications 7
- Administering pharmacological tocolysis, such as glyceryl trinitrate or beta-2 adrenoreceptor agonists, to help relax the uterus and facilitate delivery 3, 4