Delivery of an Impacted Fetal Head During Cesarean: A Literature Review and Proposed Management Algorithm

Effective and expedient management of an impacted fetal head (IFH) at cesarean delivery is essential to avoid maternal and neonatal morbidity. The incidence of an IFH at the time of cesarean may increase because of changing practice guidelines regarding the acceptable duration of the second stage of labor. Based on limited available evidence comparing the “push,” “pull,” and other methods for delivery of the IFH, we suggest the primary disengagement technique be selected based on surgeon experience and propose a management algorithm “ALERT” for clinical application. TARGET AUDIENCEObstetricians and gynecologists, family physicians LEARNING OBJECTIVESAfter completing this activity, the learner will be better able to identify risk factors for an impacted fetal head during cesarean delivery, list potential complications associated with an impacted fetal head, describe the “push” and “pull” methods of delivery of an impacted fetal head, and understand the concepts in the ALERT algorithm.