Safe delivery of the fetal head during cesarean section
Safely extracting the fetal head from a low station can turn a standard cesarean birth into an arduous procedure. Here the author describes a sequence of maneuvers to resolve the problem while minimizing strain on the incision.
Rotate. Grasp the fetal head between the thumb and fingers and rotate it so the occiput faces the incision.
FIGURE 3 THE ERR SEQUENCE
Reduce. Push the lower edge of the uterine incision down until it is posterior to the fetal head.
Conclusion
This technique for delivering the fetal head offers minimal risk of uterine laceration and lends itself to instruction and recollection.
I have not evaluated ERR by clinical trial, both due to absence of a gold-standard technique for the control group and because ERR has yielded satisfactory outcomes in the 20 years over which I have developed, applied, and taught it. Still, the technique raises opportunities for clinical investigation. For example, residency training programs concerned over their incidence of uterine extensions and lacerations may wish to adopt this method and subsequently produce a historical-controlled, retrospective cohort study as a quality-improvement project.
Dr. Chao reports no financial relationship with any companies whose products are mentioned in this article.
