Balloon disimpaction of the baby's head at emergency caesarean

The condition

2.1 When the baby's head is impacted, a caesarean carries considerably increased risks. Delivery of the baby can be difficult if the head is impacted deep within the pelvis.

Current treatments

2.2 Two approaches are commonly used to disimpact an engaged baby's head. One involves the surgeon or an assistant placing fingers through the vagina and pushing the baby's head back up the pelvis. This can be associated with vaginal tissue trauma. The other approach (reverse breech extraction) involves the surgeon delivering the baby's feet first through the uterine incision, and then delivering the head. This method can be associated with hip injury, shoulder injury and facial or neck trauma for the baby, and injury to the woman, and is avoided whenever possible. Difficulties in disimpacting a deeply engaged baby's head can delay the birth of a baby that is already at risk. There is a risk of the complications described above and also risks of obstetric haemorrhage, uterine tears, injury to uterine vessels and trauma to the urinary tract.

The procedure

2.3 Balloon disimpaction of an engaged baby's head aims to elevate the head, without trauma. It is usually done immediately before an emergency caesarean done at full dilation.

2.4 A disposable soft silicone balloon device is inserted into the vagina, using a lubricant. The balloon is pushed posteriorly towards the coccyx and placed between the pelvic floor and the baby's head. The balloon surface is placed in contact with the head while the base plate of the device rests on the anococcygeal ligament to prevent downward displacement when the device is inflated. The procedure is similar to the placement of a ventouse cup. Once the device is in position, the balloon is inflated using sterile saline through a tube connected to a 2-way tap. The balloon is designed to inflate only in an upward direction. Inflating the balloon elevates the engaged head out of the pelvis by a few centimetres. The intention is to make the birth easier, with less manipulation through the abdominal wound, and to reduce the risk of injury. Immediately after birth the balloon is deflated by opening the 2-way tap, and the device is removed from the vagina by traction. After the caesarean, the vagina is inspected for trauma.