Rates of CSFD are rising  – but this type of delivery carries a high risk of complications for both mother and baby  and is often performed out of hours and without the supervision of a senior clinician . Evidence suggests that up to 57 per cent of mothers who undergo a CSFD experience some kind of maternal morbidity, at considerable cost to the NHS. Much of this morbidity is a result of the fetal head being deeply impacted in the pelvis, requiring manual manipulation to deliver the baby.
The Fetal Pillow is a novel device designed to atraumatically elevate the fetal head out from the pelvis during a Caesarean section, making the delivery safer, easier and less traumatic.
In the study Elevation of fetal head with a Fetal Pillow during caesarean section at full cervical dilatation, a randomized controlled trial, Fetal Pillow was shown to reduce the risk of blood transfusion by 72 per cent, risk of significant uterine extension by 77 per cent, and risk of baby being admitted to NICU by 26 per cent. In addition, it reduced the length of hospital stay by one day, and operating time by 20 minutes.
The randomized controlled trial studied 240 mothers undergoing a CSFD at two teaching hospitals in West Bengal, India, between April 2013 and March 2014. They were randomly assigned one of two groups: Fetal Pillow and Non-Fetal Pillow (Conventional Techniques). The primary outcome was the incidence of severe uterine wound extensions.
Women in the Fetal Pillow group had a 77 per cent reduction in severe uterine wound extensions – just five per cent experienced one, as opposed to 32.5 per cent in the Non-Fetal Pillow group.
The authors concluded that: “with routine use of the Fetal Pillow, this unpredictable and serious situation can be managed by all grades of staff…. this has benefits for women in this emergency, for doctors who have to manage them, and for hospitals who have to cope with the emergency.”
Ramesh Ganapathy, consultant in fetal medicine, and clinical director, Epsom and St Helier Hospital, says: “CSFD is considered to be one of the most technically demanding deliveries performed by an obstetrician and is often performed out-of-hours, without immediately available senior support. Evidence shows that it carries a high risk of complications for both mother and baby.
“There are a number of different techniques to help deliver the baby. However, there is no single technique that minimises the risks associated with CSFD and improves safety for both mother and baby.
“The Fetal Pillow provides a simple and effective method to deliver the baby safely, reducing the risk of complications, and it also minimises the risks and stress for health care professionals. From my experience, use of Fetal Pillow has shown a significant trend towards improving confidence in performing this surgery, reduction in maternal morbidity, and a complementary reduction in cost of care by reducing duration of stay, and blood transfusions.”
1. A. Z. Loudon: K. M. Groom: l. Hinkson: D. Harrington: S. Paterson-Brown. Changing trends in operative delivery performed at full dilatation over a 10-year period. Journal of Obstetrics and Gynecology, 2010; 30: 370–375
2. Pergialiotis V: Vlachos D G: Rodolakis A: Haidopoulos D: Thomakos N: First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014 :175: 15–24
3. McKelvey A: Ashe R: McKenna D: Roberts R. Caesarean section in the second stage of labour; A retrospective review of obstetric setting and morbidity. Journal of Obstetrics and Gynaecology, 2010: 30: 264-267