caa a22 4500 378882627 CHVBK 20180305123435.0 cr unu---uuuuu 161128e20041104xx s 000 0 eng 10.1515/JPM.2004.152 doi (NATIONALLICENCE)gruyter-10.1515/JPM.2004.152 Blickstein Isaac 1. Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia [Elektronische Daten] [Isaac Blickstein] Cesarean section is commonly perceived as a simple and safe alternative to difficult vaginal birth. However, several trends in obstetrical practice may act in concert to cause impaction of the fetal head during the second stage of labor or, more commonly, following failed instrumental delivery. Subsequently, difficult and potentially traumatic disengagement of the deeply wedged head during cesarean section occurs. The maneuvers to disengage the wedged head include pushing (bimanual or by an assistant) the head through the vagina or, alternatively, pulling the infant's feet through the uterine incision. Although both methods may cause serious maternal and neonatal complications, available data seem to favor the pulling method and better outcome seems to depend on adequate uterine relaxation, the patient's position during operation, and special attention to the uterine incision. More data are needed to establish the frequency and extent of intraoperative disengagement dystocia and to determine the management protocol that carries the lowest risk in such circumstances. © Walter de Gruyter Human reproduction, growth & development nationallicence Gynaecology & obstetrics nationallicence Paediatric medicine nationallicence cesarean section nationallicence delivery complications nationallicence dystocia nationallicence forceps nationallicence prolonged second stage nationallicence vacuum extraction nationallicence Journal of Perinatal Medicine Walter de Gruyter 32/6(2004-11-04), 465-469 0300-5577 32:6<465 2004 32 jpme https://doi.org/10.1515/JPM.2004.152 text/html Onlinezugriff via DOI 1 research article jats NATIONALLICENCE 856 40 https://doi.org/10.1515/JPM.2004.152 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Blickstein Isaac 1. Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel NATIONALLICENCE 773 0- Journal of Perinatal Medicine Walter de Gruyter 32/6(2004-11-04), 465-469 0300-5577 32:6<465 2004 32 jpme CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-gruyter