Wyn Jones Nia, Mitchell Eleanor J, Wakefield Natalie, Knight Marian, Dorling Jon, Thornton Jim G, Walker Kate F
Clinical Associate Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Division of Population and Lifespan Sciences, University of Nottingham, UK.
Assistant Professor of Clinical Trials, Nottingham Clinical Trials Unit, University of Nottingham, UK.
Eur J Obstet Gynecol Reprod Biol. 2022 May;272:77-81. doi: 10.1016/j.ejogrb.2022.03.004. Epub 2022 Mar 4.
To determine the incidence of, and complication rates from, impacted fetal head at full dilatation Caesarean birth in the UK, and record what techniques were used.
Prospective observational study using the UK Obstetric Surveillance System (UKOSS).
159 (82%) of the 194 UK hospitals with obstetric units.
All women who underwent second stage Caesarean birth in the UK between 1st March and 31st August 2019. Further information was collected on cases where a dis-impaction technique was used, or the operating surgeon experienced 'difficulty' in delivering the head.
Prospective observational study.
Technique(s) used, maternal and neonatal outcomes.
3,518 s stage Caesarean births reported. The surgeon used a dis-impaction technique or reported 'difficulty' in 564 (16%) of these. The most common dis-impaction techniques used were manual elevation of the head by an assistant through the vagina (n = 235) and a fetal "pillow" (n = 176). Thirteen babies (2%) died or sustained severe injury. Four babies died (two directly attributable to the impacted fetal head).
Difficulty with delivery of the fetal head and the use of dis-impaction techniques during second stage Caesarean sections are common but there is no consensus as to the best method to achieve delivery and in what order.
确定英国足月剖宫产时胎头嵌顿的发生率和并发症发生率，并记录所采用的技术。
采用英国产科监测系统（UKOSS）进行前瞻性观察研究。
英国194家设有产科病房的医院中的159家（82%）。
2019年3月1日至8月31日在英国接受第二产程剖宫产的所有女性。对于采用了解除嵌顿技术或手术医生在娩出胎头时遇到“困难”的病例，收集了更多信息。
前瞻性观察研究。
所采用的技术、母婴结局。
共报告了3518例第二产程剖宫产。其中564例（16%）手术医生采用了解除嵌顿技术或报告遇到“困难”。最常用的解除嵌顿技术是助手经阴道手动抬高胎头（n = 235）和使用胎儿“枕头”（n = 176）。13名婴儿（2%）死亡或受到严重损伤。4名婴儿死亡（2名直接归因于胎头嵌顿）。
第二产程剖宫产时娩出胎头困难及使用解除嵌顿技术很常见，但对于实现娩出的最佳方法及顺序尚无共识。
