3 The procedure
3.1 Insertion of a balloon device to disimpact an engaged fetal head aims to elevate the fetal head, without trauma, immediately before an emergency caesarean section, usually at full dilatation.
3.2 A disposable soft silicone balloon device is inserted vaginally, using a lubricant. It is pushed posteriorly towards the coccyx and placed between the pelvic floor and the fetal head, usually at full dilatation of the cervix. The balloon surface is in contact with the fetal head, while the base plate of the device rests on the anococcygeal ligament, preventing any downward movement during inflation. This is similar to the placement of a ventouse cup. Once the device is in position, the mother's legs are placed flat on the operating table, and the balloon is inflated using sterile saline via a tube connected to a 2‑way tap. The balloon is designed to inflate only in an upward direction. The engaged fetal head is elevated out of the pelvis by a few centimetres. The intention is to allow the surgeon to site the uterine incision slightly higher up on the lower segment of the uterus, on a wider and thicker part of the segment, so avoiding trauma to the utero‑vesical reflection and making the delivery easier, with less manipulation. Immediately after delivery the balloon is deflated by opening the 2‑way tap, and the device is removed from the vagina by traction. Following the procedure, the vagina is inspected for trauma.