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Exploring full cervical dilatation caesarean sections-A retrospective cohort study.

Edward M A Corry1, Meenakshi Ramphul1, Ann M Rowan1

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European Journal of Obstetrics, Gynecology, and Reproductive Biology
|April 4, 2018
PubMed
Summary

The rate of caesarean sections at full cervical dilatation increased significantly over ten years. Fetal head malposition is a key risk factor, though maternal and neonatal outcomes were similar to operative vaginal deliveries.

Keywords:
Caesarean sectionFull dilatationOperative vaginal deliveryOxytocinSecond stage

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Surgical Outcomes Research

Background:

  • Rising rates of caesarean sections at full cervical dilatation internationally pose significant maternal and fetal risks.
  • This trend necessitates investigation into contributing factors and comparative outcomes.

Purpose of the Study:

  • To determine the rate of caesarean section at full cervical dilatation in a tertiary referral unit.
  • To evaluate labor, maternal, and fetal factors associated with these deliveries.
  • To compare maternal and fetal morbidity with successful operative vaginal deliveries.

Main Methods:

  • Retrospective cohort study analyzing a 10-year period of delivery data.
  • Focused analysis on single cephalic pregnancies (≥34 weeks) from an electronic database for 2015.
  • Comparison between full dilatation caesarean sections and operative vaginal deliveries.

Main Results:

  • Caesarean section at full dilatation increased by over a third (0.80% to 1.24%) over 10 years (p=0.01).
  • Fetal head malposition was significantly more common in full dilatation caesarean sections (89.1%) compared to operative vaginal deliveries (9.5%) (p<0.001).
  • Maternal and neonatal morbidity, birthweight, and postpartum hemorrhage rates were similar between the two delivery methods.

Conclusions:

  • Fetal head malposition is a significant risk factor for caesarean section at full cervical dilatation.
  • Maternal and fetal morbidity are comparable between caesarean sections at full dilatation and anticipated difficult operative vaginal deliveries.
  • Judicious use of oxytocin and improved training in diagnosing and correcting malposition may reduce caesarean section rates at full dilatation.