The use of a Fetal Pillow device at full-dilation cesarean delivery—maternal and neonatal outcomes: a retrospective study

Purpose: Impacted fetal head at full-dilation cesarean delivery (CD) is a major cause of adverse maternal and neonatal outcomes. The Fetal Pillow is a device designed to reduce these complications. Our study aims to evaluate the outcomes of full-dilation CD with and without the use of Fetal Pillow. Methods: This retrospective cohort study included full-dilation CDs performed from January 2018 to July 2023, at a single tertiary center. Indications for CDs were arrest of decent, fetal distress, and failed vacuum extraction. The study cohort included cases (Fetal Pillow group) matched to controls (without the use of Fetal Pillow) according to the indication to CD, in a 1:2 ratio. The study evaluated maternal outcomes as uterine incision extensions, maternal blood loss (ml), maternal postoperative infection, and length of hospitalization (days). Neonatal outcomes included NICU admissions, cord arterial blood pH, Apgar scores, respiratory distress, intubation, and seizures. Results: The study included 138 patients, of them 46 in the Fetal Pillow group and 92 matched controls. Maternal baseline characteristics, including age, BMI, prior CDs, and obstetric complications, were similar between groups. No significant differences were observed in median surgery duration [55 (44–68) vs. 54 (42–65) min; p = 0.361] or fetal extraction time [6 (4–8) vs. 5.5 (3–8) min; p = 0.507]. Maternal outcomes, including rates of uterine incision extensions, blood loss, and length of hospitalization, were comparable between groups. However, NICU admissions were significantly lower in the Fetal Pillow group compared to controls (17.3% vs. 33.7%, p = 0.04). In multivariable logistic regression analysis, adjusting for parity, fetal head station and position, maternal age, prior CD, and neonatal birth weight, Fetal Pillow use was associated with reduced NICU admissions [adjusted odds ratio (aOR) 0.30; 95% CI 0.11–0.82; p = 0.019]. Conclusion: The use of Fetal Pillow for impacted fetal head during full-dilation CDs may reduce NICU admissions without adversely affecting maternal outcomes.