<i>Retracted:</i> Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation

Seal, Subrata Lall; Dey, Alok; Barman, Sannyashi C.; Kamilya, Gourisankar; Mukherji, Joydev; Onwude, Joseph

doi:10.1016/j.ijgo.2015.09.019

Cited by 36 publications

(43 citation statements)

References 17 publications

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“…In the recommendations for practice, the fetal pillow receives special mention as one of the possibilities to consider when delivering a deeply impacted fetal head. 4 Seal et al 6 have completed the only RCT currently published employing the fetal pillow. They observed a decrease in their rate of uterine extension but found a major extension rate of 5% with pillow use compared to 32.5% overall in their no-pillow group.…”

Section: Discussionmentioning

confidence: 99%

“…A randomized controlled trial (RCT) was completed in 2016 in India and randomized 240 women who had a cesarean delivery at full dilatation. 6 The study suggested a benefit to patient outcomes with the use of the fetal pillow through reduced uterine angle extension (relative risk [RR] 0.37, 95% confidence interval [CI] 0.22-0.63), reduced blood loss over 1000 mL (RR 0.29, 95% CI 0.13-0.66), and reduced requirement for blood transfusion (RR 0.28, 95% CI 0.11-0.70). Data from Australia suggest that the fetal pillow may decrease blood loss intraoperatively, shorten hospital admission time, and improve fetal arterial pH when compared to the use of the "hand push" method.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of outcomes at full‐dilation cesarean section with and without the use of a fetal pillow device

Hanley

Sivanesan

Veerasingham

et al. 2020

Intl J Gynecology & Obste

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Objective To identify whether use of the fetal pillow device resulted in a reduction in intraoperative complications, such as uterine incision extension, requirement for breech extraction, etc. Other maternal outcomes (duration of hospital stay, requirement for blood transfusion, and requirement for return to hospital or operating theatre) were also reviewed. Neonatal outcomes of APGAR‐5, arterial pH, and requirement for intensive care admission were assessed. Methods A retrospective cohort analysis was completed for fully dilated cesarean deliveries completed between January 2014 and December 2018 at Ipswich Hospital, Australia. In total, 174 patient records were identified (114 with pillow, 60 without). Logistic and linear regressions were used to assess the outcomes associated with fetal pillow use. Results There were no significant differences in operative complications between the pillow and no‐pillow groups (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.26–1.22, P=0.146). Linear regression analysis showed a decrease in hospital length of stay (hours) (−9.4, 95% CI −17.80 to −0.99, P=0.029) and a higher neonatal arterial pH at delivery (0.06, 95% CI 0.03–0.09, P=0.0001) in the pillow group. Conclusion At full dilation cesarean, operative complications are not increased when employing the fetal pillow with maternal benefits of decreased hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes at full‐dilation cesarean section with and without the use of a fetal pillow device

Hanley

Sivanesan

Veerasingham

et al. 2020

Intl J Gynecology & Obste

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“…We were also unable to determine the length of the first stage and the second stage of labour. Lastly, the interventions to decrease the trauma to the uterus during the delivery of the impacted foetal head have been evaluated (Jeve et al 2016; Seal et al 2016; Waterfall et al 2016). The reverse breech extraction through the hysterotomy (the ‘pull technique’) has been compared to assistance from a vaginal hand (the ‘push’ technique) in the CDs performed for a second-stage arrest in four randomised trials.…”

Section: Discussionmentioning

confidence: 99%

Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity

Giugale

Sakamoto

Yabes

et al. 2018

Journal of Obstetrics and Gynaecology

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We conducted an observational retrospective cohort study to evaluate the risk factors and the maternal morbidity associated with unintended extensions of the hysterotomy during caesarean delivery. We evaluated 2707 women who underwent low-transverse caesarean deliveries in 2011 at an academic, tertiary-care hospital. Hysterotomy extensions were identified through operative reports. Of the 2707 caesarean deliveries, 392 (14.5%) had an unintended hysterotomy extension. On the multivariable regression modelling, neonatal weight (OR 1.42; 95%CI 1.17-1.73), the arrest of labour [first-stage arrest (2.42; 1.73-3.38); second-stage arrest (5.54; 3.88-7.90)] and a non-reassuring foetal status (1.65; 1.20-2.25) were significantly associated with hysterotomy extensions. Hysterotomy extensions were significantly associated with an increased morbidity including an estimated blood loss >1200 millilitres (2.06; 1.41-3.02), a decline in postoperative haemoglobin ≥3.7 g/dL (2.07; 1.35-3.17), an evaluation for lower urinary tract injury (5.58; 3.17-9.81), and a longer operative time (8.11; 6.33-9.88). Based on these results, we conclude that unintended hysterotomy extensions significantly increase the maternal morbidity of caesarean deliveries. Impact statement What is already known on this subject? Maternal morbidity associated with caesarean delivery (CD) is significantly greater than that in vaginal delivery. Unintended extensions of the hysterotomy occur in approximately 4-8% of CDs and are more common after a prolonged second stage of labour. The morbidity associated with hysterotomy extensions has been incompletely evaluated. What do the results of this study add? We demonstrate a rate of hysterotomy extension in a general obstetric population of approximately 15%, which is higher than previously reported estimates, and represents a potential doubling of the rate of the unintended hysterotomy extensions in recent years. The most significant risk factor for a hysterotomy extension was a second-stage labour arrest with a fourfold increase in the frequency of extensions. A hysterotomy extension is a significant independent risk factor for an intraoperative haemorrhage, a drop in postoperative haemoglobin, an intraoperative evaluation for lower urinary tract injury, and longer CD operative times. What are the implications of these findings for clinical practice and/or further research? A second-stage arrest is a strong independent risk factor for a hysterotomy extension. Recent re-evaluations of the labour curve that extend the second stage of labour will likely increase the frequency of CDs performed after a prolonged second stage. In these scenarios, obstetricians should be prepared for an unintended hysterotomy extension and for the possibility of a longer procedure with the increased risks of blood loss and the need for evaluation of the lower urinary tract.

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“…In this study the mean length of the second stage averaged 1.9 hours. 4 Compared with no Fetal Pillow, use of the Fetal Pillow was associated with a reduction in grade 3 extension of the uterine incision (extension into the uterine artery, vagina, or bladder) (2.5% vs 23%), a reduction in blood loss > 1,000 mL (4% vs 22%), and fewer difficult plus very difficult deliveries of the fetal head as reported by the surgeon (6% vs 39%).…”

Section: Effectiveness Of the Fetal Pillowmentioning

confidence: 95%

The Fetal Pillow: A new option for delivering the deeply impacted fetal head

Barbieri¹

2020

OBGM

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Retracted: Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation

Abstract: Use of the Fetal Pillow in second-stage cesarean delivery significantly reduces the risk of a major extension of the uterine incision. CTRI registration number: CTRI/2015/03/005651.

Cited by 36 publications

References 17 publications

Comparison of outcomes at full‐dilation cesarean section with and without the use of a fetal pillow device

Comparison of outcomes at full‐dilation cesarean section with and without the use of a fetal pillow device

Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity

The Fetal Pillow: A new option for delivering the deeply impacted fetal head

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