A cesarean at full dilation, with the head deep in the pelvis
The hardest cesarean there is, and one of the least discussed.
If a cesarean is needed after you have been pushing, the baby's head may be wedged deep in the pelvis and difficult to lift out. Someone may need to push up from below through the vagina while the surgeon lifts from above.
In a UK cohort of 838 emergency cesareans over one year, cesarean at full dilation accounted for 2.1% of all births, and an impacted fetal head complicated 1.5% of all births, or 11.3% of emergency cesareans. Notably, 55.8% of impacted head cases occurred before full dilation.
An impacted head independently raised the risk of the uterine incision tearing (relative risk 3.09) and of a combined adverse newborn outcome (relative risk 1.66).
The practical implicationThe longer a decision to operate is delayed once the head is deeply engaged, the more difficult the operation becomes. This is one situation where "let's give it another hour" is not always the safer choice.
Where this comes from:
291. Cornthwaite K, Draycott T, Bahl R, Hotton E, Winter C, Lenguerrand E. Impacted fetal head: a retrospective cohort study of emergency caesarean section. Eur J Obstet Gynecol Reprod Biol. 2021;261:85-91.
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