{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:58:28Z","timestamp":1779908308328,"version":"3.53.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10\u00a0years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra \u2122 set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p&lt;0.001; most severe: 25mm vs 10mm p&lt;0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44).<\/jats:p>\n                <jats:p>With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p&lt;0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p&lt;0.0001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-021-04322-2","type":"journal-article","created":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T09:02:39Z","timestamp":1642237359000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator"],"prefix":"10.1186","volume":"22","author":[{"given":"Anastasia","family":"Martin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Nzelu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Briley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Tydeman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Shennan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,15]]},"reference":[{"issue":"363","key":"4322_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4319","volume":"12","author":"J Wise","year":"2018","unstructured":"Wise J. Alarming global rise in caesarean births, figures show. BMJ. 2018 Oct;12(363):k4319.","journal-title":"BMJ."},{"issue":"3","key":"4322_CR2","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1111\/tog.12112","volume":"16","author":"N Vousden","year":"2014","unstructured":"Vousden N, Cargill Z, Briley A, Tydeman G, Shennan AH. Caesarean section at full dilatation: incidence, impact and current management. The Obstetrician & Gynaecologist. 2014;16(3):199\u2013205.","journal-title":"The Obstetrician & Gynaecologist."},{"key":"4322_CR3","doi-asserted-by":"crossref","unstructured":"Rice A, Tydeman G, Briley A, Seed PT. The impacted foetal head at caesarean section: incidence and techniques used in a single UK institution. J Obstet Gynaecol. 2019;39(7):948","DOI":"10.1080\/01443615.2019.1593333"},{"issue":"9289","key":"4322_CR4","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1016\/S0140-6736(01)06341-3","volume":"358","author":"DJ Murphy","year":"2001","unstructured":"Murphy DJ, Liebling RE, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet (London, England). 2001 Oct;358(9289):1203\u20137.","journal-title":"Lancet (London, England)."},{"issue":"10","key":"4322_CR5","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.3109\/14767051003678002","volume":"23","author":"V Govender","year":"2010","unstructured":"Govender V, Panday M, Moodley J. Second stage caesarean section at a tertiary hospital in South Africa. The journal of maternal-fetal & neonatal medicine\u00a0: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2010;23(10):1151\u20135.","journal-title":"The journal of maternal-fetal & neonatal medicine\u00a0: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians."},{"issue":"7","key":"4322_CR6","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1111\/j.1471-0528.2005.00615.x","volume":"112","author":"VM Allen","year":"2005","unstructured":"Allen VM, O\u2019Connell CM, Baskett TF. Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. BJOG\u00a0: an international journal of obstetrics and gynaecology. 2005 Jul;112(7):986\u201390.","journal-title":"BJOG\u00a0: an international journal of obstetrics and gynaecology."},{"issue":"4","key":"4322_CR7","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1097\/01.AOG.0000257121.56126.fe","volume":"109","author":"JM Alexander","year":"2007","unstructured":"Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY, et al. Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstetrics and gynecology. 2007 Apr;109(4):917\u201321.","journal-title":"Obstetrics and gynecology."},{"issue":"8","key":"4322_CR8","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1515\/jpm-2019-0216","volume":"47","author":"C Monod","year":"2019","unstructured":"Monod C, Buechel J, Gisin S, Abo El Ela A, Vogt DR, Hoesli I. Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program. Journal of perinatal medicine. 2019 Oct;47(8):857\u201366.","journal-title":"Journal of perinatal medicine."},{"issue":"7","key":"4322_CR9","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1080\/01443615.2019.1593333","volume":"39","author":"A Rice","year":"2019","unstructured":"Rice A, Tydeman G, Briley A, Seed PT. The impacted foetal head at caesarean section: incidence and techniques used in a single UK institution. Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology. 2019 Oct;39(7):948\u201351.","journal-title":"Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology."},{"issue":"12","key":"4322_CR10","doi-asserted-by":"publisher","first-page":"2386","DOI":"10.1111\/jog.14115","volume":"45","author":"M Gil","year":"2019","unstructured":"Gil M, Chill HH, Kogan L, Porat S, Levitt L, Eliasi E, et al. Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor. The journal of obstetrics and gynaecology research. 2019;45(12):2386\u201393.","journal-title":"The journal of obstetrics and gynaecology research."},{"key":"4322_CR11","doi-asserted-by":"crossref","unstructured":"Sacre H, Bird A, Clement-Jones M, Sharp A. Effectiveness of the fetal pillow to prevent adverse maternal and fetal outcomes at full dilatation cesarean section in routine practice. Acta Obstetricia et Gynecologica Scandinavica. 2020 Nov 3;n\/a(n\/a).","DOI":"10.1111\/aogs.14038"},{"issue":"2","key":"4322_CR12","first-page":"157","volume":"37","author":"N Vousden","year":"2017","unstructured":"Vousden N, Tydeman G, Briley A, Seed PT, Shennan AH. Assessment of a vaginal device for delivery of the impacted foetal head at caesarean section. Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology. 2017 Feb;37(2):157\u201361.","journal-title":"Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology."},{"issue":"6","key":"4322_CR13","doi-asserted-by":"publisher","first-page":"545","DOI":"10.3109\/01443615.2010.491566","volume":"30","author":"R Sethuram","year":"2010","unstructured":"Sethuram R, Jamjute P, Kevelighan E. Delivery of the deeply engaged head: a lacuna in training. Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology. 2010;30(6):545\u20139.","journal-title":"Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology."},{"issue":"4","key":"4322_CR14","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1080\/01443610220141290","volume":"22","author":"OB Fasubaa","year":"2002","unstructured":"Fasubaa OB, Ezechi OC, Orji EO, Ogunniyi SO, Akindele ST, Loto OM, et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods. Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology. 2002 Jul;22(4):375\u20138.","journal-title":"Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology."},{"issue":"1","key":"4322_CR15","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.ejogrb.2004.09.014","volume":"121","author":"R Levy","year":"2005","unstructured":"Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay ZJ. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. European journal of obstetrics, gynecology, and reproductive biology. 2005 Jul;121(1):24\u20136.","journal-title":"European journal of obstetrics, gynecology, and reproductive biology."},{"issue":"3","key":"4322_CR16","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.ijgo.2016.06.013","volume":"135","author":"H Safa","year":"2016","unstructured":"Safa H, Beckmann M. Comparison of maternal and neonatal outcomes from full-dilatation cesarean deliveries using the Fetal Pillow or hand-push method. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2016 Dec;135(3):281\u20134.","journal-title":"International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics."},{"issue":"3","key":"4322_CR17","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1111\/1471-0528.13593","volume":"123","author":"YB Jeve","year":"2016","unstructured":"Jeve YB, Navti OB, Konje JC. Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis. BJOG\u00a0: an international journal of obstetrics and gynaecology. 2016 Feb;123(3):337\u201345.","journal-title":"BJOG\u00a0: an international journal of obstetrics and gynaecology."},{"key":"4322_CR18","unstructured":"Barman SC, Chakraborty B, Saha S, Sahana R, Maity SRD. Use of Fetal Pillow During Cesarean Section in Deeply Engaged Head: A Comparative Study with Patwardhan\u2019s Technique. Indexed with IndMED. 2015;(0971\u20130876)."},{"issue":"3","key":"4322_CR19","doi-asserted-by":"publisher","first-page":"241","DOI":"10.3109\/01443615.2013.844108","volume":"34","author":"SL Seal","year":"2014","unstructured":"Seal SL, Dey A, Barman SC, Kamilya G, Mukherji J. Does elevating the fetal head prior to delivery using a fetal pillow reduce maternal and fetal complications in a full dilatation caesarean section? A prospective study with historical controls. Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology. 2014 Apr;34(3):241\u20134.","journal-title":"Journal of obstetrics and gynaecology\u00a0: the journal of the Institute of Obstetrics and Gynaecology."},{"issue":"2","key":"4322_CR20","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.ijgo.2015.09.019","volume":"133","author":"SL Seal","year":"2016","unstructured":"Seal SL, Dey A, Barman SC, Kamilya G, Mukherji J, Onwude JL. Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2016 May;133(2):178\u201382.","journal-title":"International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics."},{"issue":"2","key":"4322_CR21","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1002\/ijgo.13177","volume":"150","author":"I Hanley","year":"2020","unstructured":"Hanley I, Sivanesan K, Veerasingham M, Vasudevan J. Comparison of outcomes at full-dilation cesarean section with and without the use of a fetal pillow device. International Journal of Gynecology & Obstetrics. 2020;150(2):228\u201333.","journal-title":"International Journal of Gynecology & Obstetrics."},{"key":"4322_CR22","doi-asserted-by":"crossref","unstructured":"Lassey SC, Little SE, Saadeh M, Patton N, Farber MK, Bateman BT, et al. Cephalic Elevation Device for Second-Stage Cesarean Delivery: A Randomized Controlled Trial. Obstetrics & Gynecology. 2020;135(4).","DOI":"10.1097\/AOG.0000000000003746"}],"container-title":["BMC Pregnancy and Childbirth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-021-04322-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12884-021-04322-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-021-04322-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T09:04:15Z","timestamp":1642237455000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/10.1186\/s12884-021-04322-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,15]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["4322"],"URL":"https:\/\/doi.org\/10.1186\/s12884-021-04322-2","relation":{},"ISSN":["1471-2393"],"issn-type":[{"value":"1471-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,15]]},"assertion":[{"value":"26 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The clinical evalution project was approved by the Local Clinical Goverance Board at Guy\u2019s and St Thomas\u2019 NHS Trust Foundation Hospital. All methods were performed in accordance with the Guy\u2019s and St Thomas\u2019 Governance Board guidelines and regulations. Following the advice of the Health Research Authority ethical approval decisision tool, this study was not deemed to require Research Ethics Committee (REC) approval. This project only involved clinical staff and no patient participants. All study participants provided verbal informed consent for participation in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AM has no competing interestsDN has no competing interestsAB has no competing interestsGT is the creator of the Tydeman TubeAS has no competing interests","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}