Introduction
IMPACTED
Caesarean section (CS) accounts for 26% of all births in the UK, of which at least 5% are done at full dilatation in the second stage of labour, that is 34,000 births per annum [There is currently no clinical guidance on which techniques to use to manage an impacted fetal head during CS in the UK or US. There is a statement/opinion on impacted fetal head from both Canada and Australia/New Zealand [There are also no universal training programmes for maternity staff on how to manage an impacted fetal head and therefore little consensus on best practice. Reviews of the evidence also reach different conclusions, with one concluding the reverse breech extraction is associated with significantly lower maternal risks [The MIDAS study (Managing an Impacted fetal heaD At emergency caesarean Section) (NIHR HTA 17/75/09) examined the acceptability and feasibility of different techniques of managing impacted fetal head. This programme included a national survey of health professionals about current practice [The aim of this research was to qualitatively examine women’s and health professionals’ views on the acceptability and feasibility of an RCT to explore different approaches to managing an impacted fetal head during emergency CS, as well as views on the two RCT designs proposed. The results will provide the information needed to determine whether it is acceptable to conduct a future RCT in this area.