Delivery of an Impacted Fetal Head During Cesarean: A Literature Review and Proposed Management Algorithm

Obstet Gynecol Surv. 2015 Nov;70(11):719-24. doi: 10.1097/OGX.0000000000000248.


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.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Cesarean Section / methods*
  • Female
  • Fetus
  • Head
  • Humans
  • Labor Presentation*
  • Labor Stage, Second
  • Obstetric Labor Complications / etiology
  • Obstetric Labor Complications / surgery*
  • Practice Guidelines as Topic
  • Pregnancy
  • Time Factors