Assessment of a vaginal device for delivery of the impacted foetal head at caesarean section

Abstract

The aim of this study was to assess a new device (Tydeman Tube) designed to facilitate delivery of the impacted foetal head at caesarean section. Standard digital vaginal technique and the Tydeman Tube were each used to elevate the foetal head on a validated full dilatation caesarean simulator. Greater elevation of the foetal head was achieved with the Tydeman Tube than digital technique (mean difference +9.1 mm, p < 0.001). Although greater force was applied to achieve this elevation (mean difference +0.42 Kgf, p < 0.001), the force was spread over a greater area (6.97 cm² versus 2.0 cm²). Therefore, mean pressures applied to the foetal head were lower (mean difference −2.3 Kg cm², p < 0.001). The first uses of the Tydeman Tube in clinical practice were described. Clinicians found it easy to use and effective (mean score 7.7/10). The Tydeman Tube is an effective tool for delivering the impacted foetal head on a simulator and its initial use in clinical practise has proved positive.

Keywords:

• Emergency caesarean
• second stage
• impaction
• maternal trauma
• innovation

Acknowledgements

The authors would like to acknowledge the support provided by Tommy's Baby Charity and GSTT Charity. Paul Seed is partly funded by Tommy's (Registered charity no. 1060508) & CLAHRC South London (NIHR).

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The development of the Tydeman Tube was originally funded by NHS innovation in June 2009 (REF NHSIL 1841), but after £5000 being awarded this fund was disbanded. GSTC Health Innovations Ltd care of Guys and St Thomas' Charity then awarded £24500 on 31/08/2012 (REF: GiFTT19) to complete the development.