Evaluation of a Quality Improvement Project on Impacted Fetal Head at Cesarean Section

Cesarean deliveries performed during the second stage of labor can be difficult due to
impaction of the fetal head deep in the maternal pelvis and is associated with increased risk
of both maternal and perinatal complications. There is little existing data to inform
management of deeply impacted fetal heads, therefore these situations can be difficult for
surgeons and other healthcare staff when they arise. Team simulations for obstetric
emergencies have been shown to assist with provider comfort, improved clarity of thinking,
and quicker action during emergency situations resulting in improved outcomes.

This study aims to show that a simulation education project for the entire obstetric team can
decrease morbidity of difficult fetal head extraction associated with second stage cesarean
deliveries and improve provider and nursing staff confidence regarding anticipation and
management of this emergency. The simulation education project is not being conducted for the
purpose of research, but is a department-wide educational activity and Quality Improvement
project.

Inclusion Criteria:

Patient: The patient study population includes all patients age 18-45 who underwent
cesarean section during the second stage of labor (during the time period July 2014-June
2019 at Regions Hospital and Methodist Hospital) and their infants. Second stage is defined
as the time between complete cervical dilation and delivery of the infant.

Medical staff: All staff members (staff physicians, residents, nurses, surgical
technicians) at Regions Hospital who practice in the Birth Center who underwent required
simulation education regarding delivery of impacted fetal heads during second stage
cesarean section and completed the surveys as part of the QI project.

Exclusion Criteria:

Patient: Exclusion criteria include patients who underwent cesarean section in second stage
for malpresentations (i.e., breech and noncephalic presentations) and patients who
underwent cesarean section prior to 37 weeks gestation.

Medical staff: No exclusion criteria