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RCOG World Congress 2025

June 23 - 25, 2025 | ExCeL London, UK

EP.1203

Risk of uterine extensions and impacted fetal head at caesarean, by dilatation

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Poster Presenter

Jordon Wimsett

Authors

Jordon Wimsett, Meghan Hill, Charlotte Oyston, Fizra Hasan, Amanda Harvey, Jennifer Lim

Affiliations

Te Toka Tumai Auckland Hospital, Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Auckland, Te Whatu Ora Counties Manukau

Part of Topic

Hot topics (emerging research/issues) in obstetrics

Risk of uterine extensions and impacted fetal head at caesarean by dilatation

Jordon Wimsett1,2, Meghan Hill2,3, Charlotte Oyston2,3, Fizra Hasan1, Amanda Harvey2, Jennifer Lim1, Lynn Sadler1

1Te Toka Tumai Auckland Hospital, Health New Zealand, Auckland, New Zealand; 2Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Auckland, Auckland, New Zealand; 3Te Whatu Ora Counties Manukau, Health New Zealand, Auckland, New Zealand

Rationale

Uterine incision extensions and impacted fetal head (IFH) are serious complications of caesarean section at full dilatation (CSFD), but their incidence earlier in labour is unclear.

Aim

To characterise the association between cervical dilatation at caesarean section (CS), uterine incision extensions, and IFH.

Design

Observational study, with clinical record review, including a sample of the 6 632 performed at <8cm dilatation and all ≥8cm dilatation term, singleton, cephalic, live, non-anomalous pregnancies ending in CS 2019-2022 at one hospital in Auckland, Aotearoa New Zealand.

Key findings

- The risk of uterine incision extension and impacted fetal head increases with advancing cervical dilatation at CS.

- Any extension (30%), major extensions (8%) and extensions involving the cervix and/or vagina (5%) were all more common at CSFD.

- Of the CS at 8-10cm where a manoeuvre was used (IFH) 42% had a uterine incision extension compared to 24% where no manoeuvre was used.

- The most common manoeuvres used at CSFD were vaginal push (9%), tocolytic (8%), and change of surgeon (7%).

- When an IFH was encountered at CSFD, 2 or more manoeuvres were needed 34% (47/139) of the time.

- Extrapolating to all CS, from the sample reviewed, estimates that 69% of uterine incision extensions and 40% of IFH occurred prior to full dilatation.

Interpretation

- Uterine uncision extensions and IFH occurred with increasing frequency as cervical dilatation advanced.

- Two thirds of all uterine incision extensions and 40% of IFH occur before full dilatation.

- These findings are highly relevant in the context of increasing in-labour caesarean rates.