title: Delivery of an Impacted Fetal Head During Cesarean: A Literature Review and Proposed Management Algorithm.
abstract: 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.
authors.affiliation: Resident, United Family Medicine, Allina Health, St Paul, MN.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Manning
authors.affiliation: Assistant Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Tolcher
authors.affiliation: Clinical Director of Women's Services, Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust, London, UK.
authors.forename: Edwin
authors.initials: E
authors.lastname: Chandraharan
authors.affiliation: Associate Professor of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Rose
mesh_terms: D000465:Algorithms; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005333:Fetus; D006257:Head; D006801:Humans; D007746:Labor Presentation; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000209:etiology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D013997:Time Factors