Corry EMA, et al. - A retrospective cohort study was designed to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. Maternal and fetal morbidity at full dilatation sections were also assessed. Where possible, comparison of these was performed with successful operative vaginal deliveries carried out in theatre to determine key differences. Researchers identified a higher risk of full dilatation caesarean section in association with fetal head malposition. Interestingly, full dilatation caesarean sections and anticipated difficult operative vaginal deliveries carried out in theatre were similar regarding maternal and fetal morbidity. For reducing the rate of full dilation caesarean sections, the management of labour in terms of the decision to use oxytocin judiciously in hope of correcting inefficient uterine contractions and continuous labour ward training, particularly the diagnosis of malposition and its correction could be beneficial.

Methods

• In this retrospective cohort study, the rate of full dilatation caesarean section over a 10-year period were reviewed.
• Researchers performed an analysis of deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from this unit’s electronic database for 2015.

Results

• Researchers observed an increase in the rate of full dilatation caesarean section by over a third in the ten-year period [56/6947 (0.80%) vs 92/7378 (1.24%), p=0.01].
• Eighty four full dilatation caesarean sections met the inclusion criteria; of these, 63(75%) were nulliparous and the mean maternal age was 33(±5) years.
• They noted that, oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%).
• At full dilatation caesarean section, more fetal head malposition were noted (occipito-posterior, or occipito-transverse) compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001).
• Both full dilatation caesarean section and operative vaginal deliveries were similar regarding the rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml).
• In terms of mean birthweight, no difference was observed at full dilatation caesarean sections compared to operative vaginal delivery [3.88 kg (2.80 to 5.33 kg) vs 3.48 kg (1.53 to 4.40 kg)].
• No difference in neonatal morbidity was evident.