Royal College of Obstetricians & Gynaecologists, London, UK.
Translational Health Sciences, University of Bristol, Bristol, UK.
Acta Obstet Gynecol Scand. 2023 Sep;102(9):1219-1226. doi: 10.1111/aogs.14600. Epub 2023 Jul 10.
This study assessed views, understanding and current practices of maternity professionals in relation to impacted fetal head at cesarean birth, with the aim of informing a standardized definition, clinical management approaches and training.
We conducted a survey consultation including the range of maternity professionals who attend emergency cesarean births in the UK. Thiscovery, an online research and development platform, was used to ask closed-ended and free-text questions. Simple descriptive analysis was undertaken for closed-ended responses, and content analysis for categorization and counting of free-text responses. Main outcome measures included the count and percentage of participants selecting predefined options on clinical definition, multi-professional team approach, communication, clinical management and training.
In total, 419 professionals took part, including 144 midwives, 216 obstetricians and 59 other clinicians (eg anesthetists). We found high levels of agreement on the components of an impacted fetal head definition (79% of obstetricians) and the need for use of a multi-professional approach to management (95% of all participants). Over 70% of obstetricians deemed nine techniques acceptable for management of impacted fetal head, but some obstetricians also considered potentially unsafe practices appropriate. Access to professional training in management of impacted fetal head was highly variable, with over 80% of midwives reporting no training in vaginal disimpaction.
These findings demonstrate agreement on the components of a standardized definition for impacted fetal head, and a need and appetite for multi-professional training. These findings can inform a program of work to improve care, including use of structured management algorithms and simulation-based multi-professional training.
本研究评估了产科专业人员在剖宫产时遇到胎头嵌顿时的观点、理解和当前实践，旨在为标准化定义、临床管理方法和培训提供信息。
我们进行了一项调查咨询，包括在英国参加紧急剖宫产的各种产科专业人员。Thiscovery 是一个在线研究和开发平台，用于提出封闭式和自由文本问题。对封闭式回答进行简单描述性分析，并对自由文本回答进行分类和计数的内容分析。主要观察指标包括在临床定义、多专业团队方法、沟通、临床管理和培训方面选择预定义选项的参与者人数和百分比。
共有 419 名专业人员参与，其中包括 144 名助产士、216 名产科医生和 59 名其他临床医生（如麻醉师）。我们发现，胎头嵌顿定义的组成部分（79%的产科医生）和多专业管理方法的必要性（所有参与者的 95%）得到了高度认同。超过 70%的产科医生认为 9 种技术可用于胎头嵌顿的管理，但一些产科医生也认为某些潜在不安全的做法是合适的。获得胎头嵌顿管理专业培训的机会差异很大，超过 80%的助产士报告没有接受过阴道复位术的培训。
这些发现表明，胎头嵌顿的标准化定义的组成部分得到了一致认可，并且需要并渴望进行多专业培训。这些发现可以为改善护理的工作计划提供信息，包括使用结构化的管理算法和基于模拟的多专业培训。
