2 Indications and current treatments
2.1 Obstructed labour poses considerable risks to a mother and her baby, often leading to the need for an emergency caesarean section. This can be difficult if the fetal head is fixed (engaged) deep within the mother's pelvis.
2.2 Two approaches are commonly used to disimpact an engaged fetal head. One involves the surgeon or midwife placing a hand through the vagina and pushing the baby's head back up the pelvis. This is often associated with vaginal tissue trauma. The other approach (reverse breech extraction) involves the surgeon delivering the baby's feet through the uterine incision, and then delivering the head. This method is associated with fetal hip injury, shoulder injury and facial or neck trauma, and is avoided whenever possible. Difficulties in disimpacting an engaged fetal head often delay the delivery of an already compromised fetus. There is a risk of the complications described above and also risks of obstetric haemorrhage, injury to uterine vessels and trauma to the urinary tract.