Caesarean section at full dilatation- incidence, impact and current management 2014

Question 1

What proportion of CS is emergency?
What proportion fully dilated?

Answer 1

60% EMCS
2.2% Fully dilated

Question 2

How much does consultant led decision making reduced rates of EMCS?

Answer 2

40%

Question 3

What are the risks of CS at fully dilated cs 1st stage of Labour

Answer 3

Greater than double the risk of intra-operative trauma (27 vs 10%)

increased rates of maternal haemorrhage (5-10% vs 3%)

1.5 times increased rates of perinatal asphyxia

Question 4

Risk of CS at full dilatation vs Operative vaginal delivery

Answer 4

More SCBU admissions with CS at full dilatation (11% v 6%)

increased rates of maternal haemorrhage (10% vs 3%)

Question 5

Benefits of CS at full dilatation

Answer 5

Less likely to experience urinary incontinence short term (6 weeks) and long term (12 months) compared to operative vaginal delivery

Neonatal trauma (including facial/scalp bruising) less likely with CS than operative vaginal delivery (22% v 9%)

Severe neonatal trauma rates very low with CS (0% in CS 1st stage labour, 0.2% CS at full dilatation). More common with operative vaginal delivery.

Question 6

Benefit operative vaginal delivery vs fully CS

Answer 6

Less likely to report difficulty in conceiving, more likely to have further pregnancy.