DIFFICULT FETAL EXTRACTION DURING CAESAREAN SECTION WITH AN IMPACTED FETAL HEAD: A LITERATURE REVIEW

Abstract

Summary. Aim. To review recent evidence on the risk factors, diagnosis, and management of impacted fetal head during cesarean delivery. Methods. We searched PubMed and Web of Science. The review included scientific articles published in English between 2015 and 2026, along with relevant recommendations and guidelines from professional societies. Results. An impacted fetal head is an important complication of cesarean delivery that currently cannot be reliably predicted before surgery. It is more common in advanced labor and when the fetal head is low in the maternal pelvis. An impacted fetal head is associated with an increased risk of uterine incision extensions, hemorrhage, injury to adjacent structures, and neonatal trauma. Several techniques can be used to disimpact the fetal head, including vaginal push-up, reverse breech extraction, the Patwardhan technique, and selected adjunctive devices. Short-term uterine relaxation may also be considered when needed. Conclusion. Currently, no single method of impacted fetal head management is superior in all cases. The certainty of evidence comparing different techniques is low or very low. Management should be individualized according to the clinical situation, fetal position, and the operator’s experience.