Professor Kate Walker
Clinical Professor in Obstetrics
University of Nottingham
The MIDAS study was a scoping study which aimed to determine the feasiblity of a randomised trial of different techniques for managing an impacted fetal head during emergency caesarean section.
Emergency caesarean sections performed in the second stage of labour have greater morbidity for both mother and baby than those performed in the first stage. Second stage caesarean sections may be complicated by the fetal head being deeply impacted in the maternal pelvis. There are numerous techniques to assist in the delivery of an impacted fetal head, with the aim of trying to reduce the risk of harm to the mother and baby. However, there is currently no guidance on which techniques to employ for the management of an impacted fetal head at caesarean section and no training or consensus on best practice.
This study aimed to identify the techniques which should be tested in a future randomised clinical trial. It increased our understanding of the prevalence of impacted fetal head and the frequency of complications arising from it. This study also highlighted training deficiencies, and increased awareness of the problem amongst professionals and parents.
The study comprised of five work packages. Two work packages included national surveys of key stakeholders and focus groups of women who have experienced a second stage caesarean, with the aim to gather evidence as to the acceptability of each technique, and the level at which health-care professionals are trained.
Further work packages involved finding consensus from healthcare professionals as to which techniques should be used in a possible future trial and ascertaining the acceptability of such a trial.