Documentation of Impacted Fetal Head at delivery (IFH): A simulation study Jenny Summerfield, Katie Cornthwaite 

AIM 

Evaluate the accuracy of record keeping by obstetricians post simulated impacted fetal head (IFH) at caesarean section (CS) 

 

 INTRODUCTION 

• IFH is a challenging and increasingly common obstetric emergency

• IFH is associated with significant maternal and fetal complications

• Clear documentation and language is essential for obstetric management, training, audit and medicolegal purposes 

 

 IFH DEFINED AS: ‘A caesarean cephalic delivery requiring additional techniques to disimpact the fetal head after standard delivery manoeuvres have failed’ 

ADDITIONAL TECHNIQUES INCLUDED: Change of hand, tocolysis, head down tilt, vaginal disimpaction, reverse breech extraction, Patwardhan method and inverted T/J uterine incision 

 

METHOD 

• Observational study comparing observed events during simulation with post simulation documentation 

PARTICIPANTS : 

• 25 obstetricians Expert: Consultants with extensive experience Novice: ST3+ with < 7 years experience 

 

 RESULTS 

Documentation of IFH 

• The definition of IFH was met, (i.e., additional techniques used/requested) in 78% (28/36) of expert and 87% (34/39) of novice scenarios • IFH was not clearly documented in 29% (8/28) of expert and 9% (3/34) of novice simulations where additional techniques were employed • IFH was documented despite no additional techniques being used in 11% (4/36) of expert and 8% 3/39) of novice scenarios

 

 CONCLUSIONS 

• IFH was inconsistently documented following simulated IFH • Techniques performed to manage IFH were unreliably recorded, especially by expert obstetricians • Accurate documentation of disimpaction techniques is important for managing subsequent pregnancies, medicolegal purposes and for research and audit • An agreed definition of IFH and standardised proforma would be of benefit