Stratford, ON.
Hamilton, ON.
J Obstet Gynaecol Can. 2021 Mar;43(3):406-413. doi: 10.1016/j.jogc.2021.01.005.
To review the most effective clinical approaches to disengage an impacted fetal head during cesarean delivery.
Women who undergo cesarean delivery of an infant with a deeply impacted head.
The "push" technique (from below) or the "pull" technique (reverse breech extraction).
Proper management of this clinical scenario can reduce maternal and perinatal morbidity and mortality.
BENEFITS, HARMS, AND COSTS: Using an evidence-informed approach when an impacted fetal head is anticipated has the potential to reduce maternal and fetal complications and short- and long-term harm and their associated costs. Research into the value of simulation learning, regular labour assessments, and team preparedness for possible interventions will help inform quality care.
The following search terms were entered into PubMed/Medline, Google Scholar, and Cochrane for the publication period 2012-2019: • 'Guidelines' 'manual' • 'Caesarean Section' • 'full dilation' • 'operative delivery' • 'impacted head' • 'Caesarean' AND 'full dilation' AND 'impacted head' • 'Caesarean' AND 'second stage of labour' OR 'second stage' AND 'impacted head' • 'Caesarean' OR 'operative delivery' AND 'impacted head' A total of 32 articles were retrieved and 24 were deemed appropriate to include as references. Many of these articles represented expert opinion. Randomized controlled trials had small sample sizes and were conducted in settings that limit the generalizability of their findings to the Canadian population. INTENDED USERS: Intrapartum health care providers.
回顾在剖宫产分娩时使胎头脱离嵌顿的最有效临床方法。
行剖宫产分娩、胎头深嵌的产妇。
“推”法（从下方）或“拉”法（倒转臀位牵引术）。
正确处理这种临床情况可以降低母婴发病率和死亡率。
获益、危害和成本：在预计胎头嵌顿时采用循证方法，有可能降低母婴并发症及短期和长期危害及其相关成本。对模拟学习、常规分娩评估以及团队为可能的干预措施做好准备的价值的研究，将有助于提供高质量的护理。
在 PubMed/Medline、Google Scholar 和 Cochrane 数据库中，使用以下检索词检索 2012-2019 年的出版物：“指南”“手册”“剖宫产术”“完全扩张”“手术分娩”“胎头嵌顿”“剖宫产”和“完全扩张”和“胎头嵌顿”“剖宫产”和“第二产程”或“第二产程”和“胎头嵌顿”“剖宫产”或“手术分娩”和“胎头嵌顿”共检索到 32 篇文章，其中 24 篇被认为适合作为参考文献。这些文章中有许多代表专家意见。随机对照试验的样本量较小，且在限制其研究结果对加拿大人群的普遍性的环境中进行。
分娩期医护人员。
