|January 2003 · Vol. 15, No. 1
Safe delivery of the fetal head during cesarean section
Safely extracting the fetal head from a low station can turn a standard cesarean birth into an arduous procedure. Here the author describes a sequence of maneuvers to resolve the problem while minimizing strain on the incision.
Dr. Chao is attending perinatologist, Santa Clara Valley Medical Center, San Jose, Calif, and assistant clinical professor of OBG at Stanford University School of Medicine,
Position yourself so your upper trunk, arm, and hand move as a unit to elevate the head.
Elevate the head to the level of the uterine incision, rather than bringing the incision down to the head.
Rotate the occiput anteriorly to present the shortest fetal head diameters to the incision.
Reduce the lower lip of the uterine incision beneath the fetal head, as you would reduce a posterior cervical lip at a vaginal delivery.
Although it’s a skill vital for cesarean birth, manual delivery of the fetal head from a low pelvic station is given only cursory coverage in standard obstetrics texts and reviews.1-4 To learn successful methods, therefore, physicians are forced to rely on observation, anecdotal experience, and—least desirably—trial and error.
Possibly the most frequently employed maneuver in this scenario is to have an assistant elevate the head with his or her hand.1,3,4 However, this technique may not provide sufficient elevation. Furthermore, subsequent manipulation by the clinician may extend the uterine incision and risk injury to the uterine vessels and bladder. It is an untested assumption that such extensions increase the risk of uterine rupture during subsequent trials of labor.