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University College London Hospital, London, UK - Case Study
Introduction
Incidence of caesarean section performed at full dilatation is increasing. Delivery can be technically challenging and associated with increased maternal and neonatal morbidity. The objectives of this study were to evaluate local caesarean section rate at full dilatation, assess the indications, review the maternal and neonatal morbidity and identify any training issues.
Methods
Ketrospective collection or data or women with cephalic and singleton pregnancies who required CS at lull dilatation from 1st |an 2014 till 31st Dec 2014 at University College London I lospilal.
Results
During the study, 101/6,408 (1.58%) women required CS at frill dilatation. Majority were nulliparous and in spontaneous labour. 61% were performed after 10 pin. Only one third of cases had an attempt at instrumental delivery. 37% cases had no documented presence of senior obstetrician at delivery while 54% were performed by junior registrars. 24% had uterine extensions. Methods to disimpact fetal head at CS (push, pull or fetal pillow) did not show a difference in preventing uterine extensions. 8% of neonates had arterial Ph <7.10, required NICU admission and one had cephalhaematoma. Comparison of primary CS and failed instrumental delivery did not show adverse neonatal outcome in attempt at instrumental delivery but slightly increased occurrence of maternal PPH, pyrexia and prolonged postnatal stay in failed instrumental group.
Conclusion Cacsarean section at full dilatation is associated with increased maternal but lower neonatal morbidity. Involvement of senior obstetrician is important in decision making and providing safer delivery. Specific drills and simulation training can help to reduce the force used for successful delivery.