Ragbourne S C, Charles E, Herincs M, Desai N
Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Honorary Senior Clinical Lecturer, King's College London, London, United Kingdom.
Int J Obstet Anesth. 2025 Feb;61:104268. doi: 10.1016/j.ijoa.2024.104268. Epub 2024 Sep 16.
Impacted fetal head occurs when the fetal head is deeply engaged within the maternal pelvis and difficult to deliver during caesarean delivery. In order to deliver the fetal head, additional surgical manoeuvres and/or pharmacological tocolysis are needed. The aim of this focused review is to outline the incidence, risk factors, management and complications of this obstetric emergency from the perspective of the anaesthetist.
Databases were searched for free text headings and subject headings associated with different permutations of terms related to impacted fetal head and caesarean delivery.
Impacted fetal head has been estimated to occur in 1.5 % of elective caesarean deliveries and 2.9-18.4% of all emergency caesarean deliveries at any cervical dilatation. Risk factors include advanced cervical dilatation, labour augmentation with oxytocin, prolonged second stage of labour, fetal malposition and junior grade of operating obstetrician. If impacted fetal head occurs, the anaesthetist in conjunction with the multidisciplinary team should consider decreasing the height of the operating table, providing a step for the obstetrician to stand on, placing the patient in the head down position, providing pharmacological tocolysis with glyceryl trinitrate (or nitroglycerin), beta-2 adrenoreceptor agonists or volatile anaesthetic agents, and managing complications such as postpartum haemorrhage.
Impacted fetal head is an obstetric emergency that the anaesthetist should be familiar with and has a vital role in managing. We propose an algorithm for management that may serve as a clinical decision aid.
当胎儿头部深深嵌顿于母体骨盆内且剖宫产时难以娩出时，就会发生嵌顿性胎头。为了娩出胎儿头部，需要额外的手术操作和/或药物性宫缩抑制。本综述的目的是从麻醉医生的角度概述这种产科急症的发生率、危险因素、处理方法及并发症。
检索数据库，查找与嵌顿性胎头和剖宫产相关术语的不同排列组合的自由文本标题和主题词。
据估计，在择期剖宫产中，嵌顿性胎头的发生率为1.5%，在所有急诊剖宫产中，无论宫颈扩张程度如何，其发生率为2.9% - 18.4%。危险因素包括宫颈扩张程度高、使用缩宫素加强宫缩、第二产程延长、胎位异常以及产科手术医生年资较低。如果发生嵌顿性胎头，麻醉医生应与多学科团队一起考虑降低手术台高度、为产科医生提供站立台阶、将患者置于头低体位、使用硝酸甘油（或硝化甘油）、β - 2肾上腺素能受体激动剂或挥发性麻醉剂进行药物性宫缩抑制，并处理产后出血等并发症。
嵌顿性胎头是一种产科急症，麻醉医生应熟悉并在处理中发挥重要作用。我们提出了一种处理算法，可作为临床决策辅助工具。
