Impacted fetal head in full dilatation C-sections linked to longer surgical times and lower Apgar scores

Performing a caesarean section (CS) at full cervical dilatation (FDCS) is a complex obstetric emergency, often associated with increased maternal and neonatal morbidity. A significant challenge during FDCS is the presence of an impacted fetal head (IFH), where the fetal head is deeply engaged in the pelvis and difficult to dislodge. Current management techniques for IFH vary widely, and there is a lack of consensus on its definition and optimal approach, potentially leading to inconsistent outcomes. This variability highlights a critical gap in clinical practice and training, underscoring the need for clearer guidelines to improve safety and efficiency during these high-risk deliveries.

This retrospective cohort study analyzed singleton, cephalic pregnancies undergoing full dilatation caesarean sections (FDCS) over one year (October 2024 - October 2025). Researchers identified 1,134 category 1 and 2 emergency CS cases with documented cervical dilatation, of which 105 (9%) were FDCS. Cases were then divided into two groups: those with documented impacted fetal head (IFH) and those without. Maternal demographics and intrapartum characteristics were compared using Student's t-test, Mann-Whitney U, and chi-squared tests. For IFH cases, additional management techniques, such as vaginal push up, were recorded and summarized.

Of the 105 FDCS cases, 58% were complicated by an impacted fetal head (IFH), a higher incidence than previously reported, likely due to improved recognition. No significant differences were observed in intrapartum characteristics like induction of labor, oxytocin use, or trial of instrumental delivery between IFH and non-IFH groups. Additional techniques were required in 42% of IFH cases, with vaginal push up being the most common at 52%. IFH was significantly associated with prolonged operative times:

27% (16/59) of IFH cases had an incision-to-delivery time of ≥3 minutes, compared to 0% (0/43) in non-IFH cases (p < 0.001). Surgical time was also longer, with 31% (18/59) of IFH cases taking over one hour versus 9% (4/43) of non-IFH cases (p = 0.01). Neonatal outcomes showed lower Apgar scores at 1 minute in the IFH group (8 [1-9] versus 9 [5-10], p = 0.003), though other operative, postnatal, and neonatal outcomes did not show meaningful differences.