scholarly journals A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anastasia Martin ◽  
Diane Nzelu ◽  
Annette Briley ◽  
Graham Tydeman ◽  
Andrew Shennan
Keyword(s):  
Caesarean Section ◽  
Neonatal Morbidity ◽  
Previous Experience ◽  
Fetal Head ◽  
Digital Technique ◽  
Second Stage ◽  
Head Elevation ◽  
Digital Elevation ◽  
Single Operator ◽  
Established Technique

Abstract Background The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant. Methods We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded Results The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44). With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001). Conclusion On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

scholarly journals Study of fetomaternal outcome in second stage caesarean section

2019 ◽  
Vol 8 (6) ◽  
pp. 2169 ◽  
Author(s):  
Kamal D. Goswami ◽  
Manisha M. Parmar ◽  
Avnika N. Kunjadiya
Keyword(s):  
Caesarean Section ◽  
Prospective Observational Study ◽  
Febrile Illness ◽  
Neonatal Morbidity ◽  
Cervical Dilatation ◽  
Bladder Injury ◽  
Fetal Head ◽  
Second Stage ◽  
Uterine Incision ◽  
Tertiary Teaching

Background: The incidence of second stage caesarean section is more in developing countries. Caesarean sections done at full cervical dilatation with impacted fetal head are difficult and associated with an increased incidence of maternal and fetal complications.Methods: This was prospective observational study conducted at a tertiary teaching institute. All second stage caesarean sections performed between September 2017 to August 2018 were analysed in terms of incidence, indications of caesarean-section, intra-operative  and postoperative complications, maternal and fetal outcome.Results: During the study period there were total 7270 deliveries. Out of this 1884 deliveries were done by caesarean section. Out of them 50 were 2nd stage caesarean sections contributing to 2.65% of total sections. Patwardhan method was used in 50% cases for deliveryof deeply engaged head. Intra-operative complications were higher in terms of atonic pph (8%), extension of uterine incision (16%), in 3 cases bladder injury was noticed. Obstetric hysterectomy was required  in 4% cases. 14% cases had postoperative febrile illness and 8% cases had wound infection. 44% babies required NICU admissions and neonatal death was 18%.Conclusions: Caesarean section in the 2nd stage of labour is associated with significantly increased maternal morbidity. Neonatal morbidity and mortality also increases. A proper judgement is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.

scholarly journals Maternal outcomes following second stage caesarean section in a tertiary hospital in Malaysia: A 6-year retrospective review

2021 ◽  
Author(s):  
Nurul Nafizah Mohd Rashid ◽  
Nik Mohamed Zaki Nik Mahmood ◽  
Mohd Pazudin Ismail ◽  
Adibah Ibrahim ◽  
W Fadhlina W Adnan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Post Partum ◽  
Neonatal Morbidity ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
High Rate ◽  
Maternal Outcomes ◽  
Total Blood ◽  
Second Stage

Introduction: The trend for second stage caesarean section (SSCS) has been rising, and it carries a high rate of maternal and neonatal morbidity. Aim: To determine the prevalence of caesarean section (CS) performed during the second stage of labour and identify maternal outcomes and associated risk factors in these women. Material and methods: This retrospective study was performed in the Hospital University Sains Malaysia (HUSM). Medical records of 207 women with singleton cephalic pregnancies at term who underwent a SSCS between January 1, 2010 and December 31, 2015 were reviewed, and demographic and outcome data were collected. Results and discussion: During the study period, 8,197 (19.3%) out of 42,546 babies were delivered by CS, including 257 (4.1%) SSCSs. Nearly half (49.3%) the women were nulliparous, 182 (87.9%) experienced spontaneous labour and 123 (59.4%) received oxytocin augmentation. Furthermore, 26 (12.6%) of women had post-partum haemorrhage (≥1000 mL), of whom 22 (10.6%) required blood transfusion. Only 1 (0.5%) woman was admitted to the intensive care unit postoperatively, but 163 (78.7%) had an overall hospital stay length of 3 days. Furthermore, 38 (18.4%) and 33 (15.9%) of women experienced extended uterine tear and uterine atony, respectively. Parity (P < 0.001), attempted instrumentation (P < 0.001) and baby’s weight (P < 0.004) were statistically significantly associated with total blood loss. Parity (P < 0.012) and attempted instrumentation (P < 0.001) were risk factors for extended uterine tear. Conclusions: The overall outcomes from SSCS were better compared with studies performed in other centres. Current practices must be maintained or improved to provide the best patient caree.

scholarly journals Maternal and foetal outcome in second stage caesarean section: a prospective study

2021 ◽  
Vol 10 (4) ◽  
pp. 1644
Author(s):  
Shuchi Sharma ◽  
Poojan Dogra ◽  
Reena Sharma ◽  
Suraj Bhardwaj
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Cervical Dilatation ◽  
Bladder Injury ◽  
Fetal Head ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Adjacent Structures ◽  
A Prospective Study

Background: Caesarean section is the most commonly performed abdominal operation in women all over the world. Caesarean sections during the second stage labour accounts for approximately one fourth of all primary caesareans.  Caesarean section at full cervical dilatation is technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased haemorrhage and infection. Aims and objectives were to determine the indications, maternal and foetal morbidity associated with caesarean section in the second stage of labour.Methods: This prospective study included consecutive 50 cases of caesarean section deliveries conducted in second stage of labor for singleton live pregnancies at term. The data collected in the study was analyzed in terms of maternal demographics, indications of caesarean section, intra-operative and postoperative complications and neonatal outcomes.Results: In our series of 50 deliveries, arrest of descent of fetal head due to malposition was the most common indication of caesarean section accounting for 74% and average procedure time was 45-70 minutes. PPH (62%) was the most common complication. Bladder injury was found in 14% cases. Neonatal outcome variables like APGAR<3 at 5 minutes, respiratory distress and neonatal death were observed in 7, 26 and 2 deliveries respectively.Conclusions: Women undergoing cesarean section in second stage of labour are associated with increased maternal and fetal morbidity. They require special care and hence operation should ideally be performed and supervised by an experienced obstetrician. A proper judgement is required to take a decision for caesarean section at full cervical dilatation.

scholarly journals Caesarean Section During Second Stage of Labor in a Tertiary Centre

2017 ◽  
Vol 15 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Padma Gurung ◽  
Sameer Malla ◽  
Sushma Lama ◽  
Anagha Malla ◽  
Alka Singh
Keyword(s):  
Caesarean Section ◽  
Post Partum ◽  
Caesarean Section Rate ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Perinatal Complications ◽  
Maternal Complications ◽  
Postoperative Fever ◽  
Second Stage Of Labor ◽  
Second Stage

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour.Methods: This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity.Results: During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.

scholarly journals First versus second stage caesarean section: a comparison of maternal and neonatal outcomes

2017 ◽  
Vol 6 (8) ◽  
pp. 3477
Author(s):  
Sushma Sinha ◽  
Surya Malik ◽  
Mala Dixit
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Caesarean Delivery ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
P Value ◽  
Neonatal Complications ◽  
Second Stage ◽  
Number Of Patients ◽  
One Year

Background: A retrospective study was done to compare the maternal and neonatal complications of caesarean delivery performed in the second stage compared with the first stage of labor.Methods: This is a one year retrospective study done in a 100-bedded hospital, govt of NCT OF Delhi, New Delhi from 1st November 2015 to 31st October 2016.  Total number of deliveries in this one year duration were 1785, including both normal and caesarean deliveries. Total number of patients who underwent caesarean delivery in the first stage of labor were 159, and in 2nd stage of labor were 15 during this time period. These were designated into two groups, group 1 and group 2. These two groups were then compared in terms of maternal demographics, labor characteristics, maternal outcomes and neonatal outcomes. Numerical variables were compared between groups by calculating P-value for each variable. P-value <0.05 was considered statistically significant.Results: Caesarean deliveries performed in the second stage were associated with increased maternal morbidity in terms of blood loss, unintended extensions, blood transfusions, prolonged hospital stay, febrile morbidity. Similarly, Neonatal morbidity was much higher in the patient who underwent LSCS in 2nd stage of labor compared to 1st stage. There was increase in neonatal complications, for e. g. –5 minute Apgar <7, NICU admissions >24 hrs, neonatal septicaemia, (P-value <0.05).Conclusions: In conclusion, present study suggests that women undergoing caesarean section in the second stage of labor have increased maternal and fetal morbidity. Therefore, selection of birthing method should be made very carefully and meticulously to decrease maternal and neonatal morbidity.

scholarly journals Review of caesarean sections at full dilatation

2017 ◽  
Vol 6 (6) ◽  
pp. 2491 ◽  
Author(s):  
Vijaya Monish Babre ◽  
Kirti Rajesh Bendre ◽  
Geeta Niyogi
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Maternal Morbidity ◽  
Intraoperative Complications ◽  
Febrile Illness ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Second Stage ◽  
Uterine Incision ◽  
Tertiary Teaching

Background: To study indications of second stage caesarean section. To study intraoperative and postoperative complications. To review maternal and perinatal outcome.Methods: This retrospective study was conducted at a tertiary teaching Institute. All second stage caesarean sections performed between a period 2008 to 2012 were analysed in terms of duration of 2nd stage of labour, instrumentation attempted prior to caesarean section, indication of caesarean-section, Intraoperative complications, maternal and perinatal outcome.Results: During the study period 2760, caesarean sections were performed out of them 61 were 2nd stage caesarean section. Out of 61 Caeserean 14 were given prior instrumental trial, followed by 2nd stage caesarean section. Intraoperative complications were higher in terms of blood loss, primary PPH, extension of uterine incision, in one case bladder injury was noticed. Patwardhan method was used in 23% cases for delivery deeply engaged head. Atonic PPH was seen in 11.5% of patiants.3.3% of patients had extension of uterine incision. 54% baby’s required NICU care. Increased incidence of post-operative febrile illness and wound infection were noted.Conclusions: Caeseraen section in the 2nd stage of labour is associated with significantly increased maternal morbidity. Neonatal morbidity and mortality also increases. A proper judgement is required by a skilled obstetrician to take a decision for instrumental delivery or ceaseraen section at full cervical dilatation.

scholarly journals A prospective observational study of fetomaternal outcome in second stage caesarean section

2019 ◽  
Vol 8 (12) ◽  
pp. 4798
Author(s):  
Isha . ◽  
Prabha Lal ◽  
Vikram Dutta ◽  
Aayushi Kaushal
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Caesarean Section Rate ◽  
Birth Asphyxia ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Intraoperative Complication ◽  
Second Stage ◽  
Second Stage Of Labour

Background: Incidence of caesarean section is rapidly rising over last two decades and one fourth is contributed by caesarean section in second stage. The objective of this study was to study of fetomaternal outcome in second stage caesarean section.Methods: Prospective observational study was done in 80 women undergoing second stage caesarean section from December 2015 to March 2017 at Lady Hardinge Medical Collage Delhi. These women observed from labour to caesarean section in second stage of labour till post-operative period for any complication. Intraoperative and postoperative complications were observed in these women.Results: Caesarean section rate was 22% in which 3.9% were done in second stage of labour. Most common gestational age being 39-40 weeks (47%). Most common indication being deep transverse arrest (41.25%). Intraoperative complication as bladder injury (5%), extension of uterine incision (23%), PPH (33%) and need for blood transfusion (31%) and post-operative complication as wound sepsis in 58% and 20% requiring resuturing, post-operative fever, prolong hospital stay, prolonged catheterization etc. neonatal complications as severe birth asphyxia (2.5%), respiratory distress (55%), need for mechanical ventilation.Conclusions: Thus, caesarean section done in second stage of labour is associated with increased maternal and neonatal morbidity.

scholarly journals The acceptability to women of techniques for managing an impacted fetal head at caesarean section and of randomised trials evaluating those techniques: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabriella Romano ◽  
Eleanor Mitchell ◽  
Rachel Plachcinski ◽  
Natalie Wakefield ◽  
Kate Walker ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Healthcare Professionals ◽  
Informed Choice ◽  
Structured Interviews ◽  
Fetal Head ◽  
Emergency Situations ◽  
Second Stage ◽  
Systematic Sample ◽  
Women’S Views

Abstract Background This study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area. Methods Qualitative semi-structured interviews with a systematic sample of women who experienced second stage emergency caesarean section at a tertiary National Health Service (NHS) hospital in England, UK. Thematic analysis was used to extract women’s views. Results Women varied in their perceptions of the acceptability of different techniques for managing impacted fetal head. Trust in medical expertise and prioritising the safety of the baby were important contextual factors. Greater consensus was found around informed choice in trials where subthemes considered the timing of invitation, reduced capacity to give consent in emergency situations, and the importance of birth outcomes and having good rapport with healthcare professionals who invite women into trials. Finally, women reflected on the importance of supportive antenatal and postpartum education for impacted fetal head. Conclusions This research provides information on the acceptability of techniques and any trial to evaluate these techniques. Findings illustrate the importance of context and quality of care to both acceptability and approaching women to take part in a future trial.

scholarly journals Retrospective study of maternal and neonatal outcome in second stage lower segment caesarean section in a tertiary hospital

2020 ◽  
Vol 9 (12) ◽  
pp. 4924
Author(s):  
M. P. A. Sailakshmi ◽  
Vidhyadhare G. S.
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Neonatal Morbidity ◽  
Tertiary Hospital ◽  
Clinical Exposure ◽  
Medical College ◽  
Lower Segment Caesarean Section ◽  
Second Stage ◽  
Safe Performance

Background: Caesarean section at second stage are increasing and are associated with significant maternal morbidity. The overall caesarean section rates are also increasing from last two decades.Methods: A retrospective study conducted in Department of Obstetrics and Gynaecology, Raja Rajeswari Medical College and Hospital, Bangalore from January 2018 to July 2019. Second stage LSCS were analysed in terms of indications, intraoperative and post-operative complications, neonatal morbidity.Results: In our hospital during study period there were 2639 deliveries and total number of LSCS 1146 (43.42%) and caesarean section rate was 35-45% and second stage LSCS 60 (5.23%).Conclusions: Second stage LSCS associated with more number of maternal and neonatal morbidity. Adequate clinical exposure and appropriate training are essential for safe performance in second stage LSCS. 

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