Retention of the After-Coming Head

Abstract

Retention of the after-coming head refers to the rare situation in which there is difficulty in extracting the fetal head in vaginal breech delivery (Fig. 4.1). The incidence of breech presentation in labour varies according to gestational age, from about 23 % at 28 weeks to 3–4 % at term. The latter incidence depends also on local practices for the promotion of external cephalic version. The number of vaginal breech deliveries complicated by retention of the after-coming head is largely dependent on local policies of case selection for elective caesarean section. Footling or knee presentations, fetuses with estimated birth weights above 3800 g or below 1500 g and those with extended heads are common indications for caesarean section, but criteria may vary between centres. Some studies report retention of the after-coming head to occur in as much as 10 % of vaginal breeches, but the criteria used for the diagnosis are questionable.