A key new chapter in this edition of the PROMPT Course Manual. Impacted fetal head is a previous unrecognised obstetric emergency with significant recent interest internationally. The chapter explores the underlying risk factors, recognition, management and potential complications arising in impacted fetal head. A brand new chapter exploring the underpinning research and literature with four clear algorithms to explore the manoeuvres and considerations needed by the multi-professional team. Key learning points: If impacted fetal head (IFH) at caesarean birth is anticipated, the theatre team and senior maternity team members should be alerted. If the obstetrician is unable to disimpact the fetal head at caesarean birth using standard manoeuvres, ‘impacted fetal head’ should be calmly declared and help requested. The obstetrician should pause to allow relaxation of the uterus and be aware that there may be more space to get below the fetal head laterally. Flexion of the fetal head is key to effective disimpaction. During abdominal cephalic disimpaction, the fetal head should initially be elevated towards the woman’s head. For vaginal disimpaction, the woman’s legs should be flexed and abducted. A whole hand should be used to cup, flex and elevate the fetal head. If no progress is achieved with a manoeuvre, the team should be prepared to move on to another manoeuvre. Where impacted fetal head has occurred, it should be clearly documented with the techniques employed to facilitate birth.