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Re: Delivery of the impacted headFrom: douglas krell (douglas.krell@nsionline.com)Wed Nov 27 19:16:13 1996
We do 1 or 2 maneuvers that aid us in delivering impacted heads at the time of Cesarean. We examine the patient after the block has been administered and elevate the vertex. This is easy to do when a trial of forceps under surgical anesthesia has failed or else just prior to scrubbing. If this was not done, then the circulating nurse reaches under the drapes and helps to push the head up from below. It is an eerie feeling to reach down below the head and touch the nurses fingers, but it works well enough. Together we take an extra ten seconds and apply gentle upward pressure. I think that being in too great a hurry at this point winds up tearing the lower uterine segment. I've never tried delivering these babies as breeches, but it seems a little bit like scratching your nose through your trouser's zipper.
-- Douglas Krell MD
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