National Institute for Health and Clinical Excellence (NICE)
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Fetal balloon procedure is safe for delivering ‘stuck’ babies, NICE says

A balloon inflated underneath a baby’s head after they have become stuck in the pelvis during labour could be used to safely deliver them, NICE has said

New evidence seen by NICE’s interventional procedures advisory committee showed the procedure was safe and effective to be used by maternity staff trained in managing impacted babies’ heads during an emergency caesarean birth.

The aim of the procedure is to elevate the baby’s head away from the mother’s pelvis without trauma.

In the procedure a disposable soft silicone balloon device is inserted into the vagina, using a lubricant. It is pushed towards the coccyx and placed between the pelvic floor and the baby’s head.

The balloon surface is placed in contact with the head while the base plate of the device rests on the anococcygeal ligament to prevent downward displacement when the device is inflated.

Once in position, the balloon is inflated using sterile saline through a tube connected to a 2-way tap. The balloon is designed to inflate only in an upward direction. Inflating the balloon elevates the engaged head out of the pelvis by a few centimetres. The intention is to make the birth easier, with less manipulation through the abdominal wound, and to reduce the risk of injury to both mother and baby.

Immediately after birth the balloon is deflated by opening the 2-way tap, and the device is removed from the vagina by traction. After the caesarean, the vagina is inspected for trauma.

Dr Gail Allsopp, interim chief medical officer at NICE, said: “Having an emergency caesarean because your baby’s head has become stuck in the pelvis will be a traumatic time for a mother.

“Using a fetal balloon is an option for the delivery team, if trained, to help during an emergency caesarean section, aiming to deliver the baby safely.

“This evidence-based recommendation will help to drive an innovative product into the hands of health and care professionals to enable best practice.”

In this UK study, 159 (82%) of the 194 hospitals with obstetric units in the UK, reported 3,518 second stage Caesarean sections, (estimated to be 7.3% of emergency Caesarean births in those hospitals). There were 557 reports of the use of a dis-impaction technique or of “difficulty” delivering the head in the final analysis. The fetal pillow was used 142 times as a preventative measure (25%) and 34 times as treatment, in all cases the pillow was placed and inflated.

The committee noted that there were not any major safety concerns with this procedure.

The procedure is recommended by NICE to be used under standard arrangements for clinical governance, consent and audit for use by trained NHS maternity staff.

Read the NICE guidance for balloon disimpaction of the baby’s head at emergency caesarean during the second stage of labour

Channel website: https://www.nice.org.uk/

Original article link: https://www.nice.org.uk/news/fetal-balloon-procedure-is-safe-for-delivering-stuck-babies

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