Caesarean section at full dilatation

Abstract

To learn about the possible maternal and fetal complications associated with the second-stage caesarean sections. Techniques to perform safer second-stage caesarean sections. Techniques to identify and deal with the fetal and maternal complications Preventative measures that can be adopted to reduce and prevent fetal and maternal complications. Incidence and epidemiology: There are currently no precise figures for the incidence of caesarean section at full dilatation, but given that there are around 200 000 caesarean births in the UK each year with around 10% at full dilatation, it potentially affects around 20 000 births per year. According to the audit figures of the RCOG, around 35% of caesareans for singleton pregnancies are performed because of failure to progress in labour, of which one-quarter occur at full cervical dilatation. In 55% of these cases, no attempt was made to achieve a vaginal birth with either forceps or ventouse. In those births where OVB was attempted, the audit found a failure rate of 35% for ventouse and 2% for forceps. Background: Loudon et al. demonstrated that over the decade from 1992 to 2001, the use of forceps declined whilst the use of the ventouse increased, although this was associated with a higher failure rate. There was an increase in caesarean sections at full dilatation due to both failure of OVB and an increased reluctance to perform it. Whether this is directly attributable to reduced junior doctor hours and, therefore, clinical training and experience, or whether it is simply the continuation of a trend towards lower thresholds for caesarean section, is impossible to decipher. It is noteworthy that, in the 2009 Postgraduate Medical Education and Training Board (PMETB) trainees' survey, 8.8% of trainees said that, if faced with a woman at full dilatation with a fetal malposition and station below the ischial spines, they would expedite birth by caesarean section without an attempt at OVB. This survey showed that an increasing number of women were being taken to theatre at full dilatation, and that in itself may have influenced the mode of birth by lowering the threshold for caesarean section.