The impacted fetal head at cesarean delivery, incidence, complications and management options, including a new device.

Abstract

Worldwide, the rate of cesarean delivery continues to increase. Globally, 1 in 5 women give birth via cesarean delivery, with 1 in 3 women in the United Kingdom, United States, and Australia. Approximately one-quarter of all deliveries are by cesarean delivery during labor. Cesarean delivery during labor, particularly at advanced and full dilatation, can be challenging. In addition, cesarean deliveries are associated with increased risks of neonatal and maternal morbidities, especially if the fetal head is "impacted" or wedged in the maternal pelvis, which makes delivery difficult. There is no consensus on the optimum management of an impacted fetal head, and multiple techniques have been described. The Tydeman Tube is a novel disimpaction and vacuum release device designed for managing an impacted fetal head. It consists of a semirigid wide-bore silicone tube and a flexible silicone cup for use in the late first stage and second stage of cesarean delivery. This article outlines the scope of the issue of an impacted fetal head and presents the rationale for the development of a novel device, the Tydeman Tube, including a description of the device, its mechanism of action, and preliminary findings from early studies.