Management of impacted fetal head during emergency caesarean section
Research type
Research Study
Full title
A STUDY TO DETERMINE THE FEASIBILITY OF A RANDOMISED TRIAL OF DIFFERENT TECHNIQUES FOR MANAGING AN IMPACTED FETAL HEAD AT EMERGENCY CAESAREAN SECTION
IRAS ID
260075
Contact name
Kate F Walker
Contact email
Sponsor organisation
University of Nottingham
Duration of Study in the UK
2 years, 0 months, 0 days
Research summary
Approximately one in four women give birth by caesarean section and about five in a hundred of these operations are done near the end of labour when the neck of the womb is fully open and the head has already entered the pelvis. These operations are often complicated. If the baby’s head is deeply wedged in the woman’s pelvis it can be difficult to lift it up, so delivery of the baby’s head at caesarean can occur. As a result tears to the womb and vagina can cause bleeding. There can also be problems for the baby, such as broken bones and brain damage from lack of oxygen. Occasionally babies may die from this cause.
There are a number of ways to make such births easier; an assistant can push the head up with their hand from the vagina, or a specially designed balloon in the vagina can achieve the same effect. Sometimes the surgeon delivers the baby’s feet or arms first. Doctors can also use medicines that cause the womb to relax to allow more room for manoeuvre. We do not know which of these methods is best for the mother and the baby.
The NHS would like to conduct research in this area. Before they do so they want to find out from doctors and midwives, how common the problem is, what techniques are currently in use and which ones should be tested in future research projects. We also need to determine how acceptable research in this area is.
We will survey doctors who perform caesarean births, and midwives to find out which techniques they use, how they learned about them, and what training needs they have. We will also perform a national survey of parents and conduct face to face discussions with groups of women who have experienced this type of Caesarean birth to hear their views.
We will perform a survey of hospitals throughout the UK to find out what poor outcomes and difficulties occurred in late labour Caesarean births, what manoeuvres were attempted and what the outcomes were for women and their babies.
The end goal is to design a clinical study into one or more techniques to deliver a head that is stuck in the pelvis at Caesarean birth. We will ask women and experienced doctors at focus groups whether they would be willing to be involved in such a study, and what they feel the challenges would be.
REC name
West Midlands - Solihull Research Ethics Committee
REC reference
19/WM/0118
Date of REC Opinion
14 May 2019
REC opinion
Further Information Favourable Opinion