Changing trends in operative delivery performed at full dilatation over a 10-year period

Abstract

This study was a systematic anonymous audit of routinely collected data in a tertiary referral obstetric unit in London and included data from deliveries over a 10-year period (1992-2001). Data for all caesarean sections at full dilatation were collected, including maternal demographic information, the grade of operating clinician, and the place of delivery. Neonatal data collected included birth weight and umbilical arterial pH. No changes in the demographics of the population were observed. No increased rates of malposition were observed. Birth weight did not change. Increasing preference for the ventouse over forceps (ratio 0.2:1 to 1.9:1) over the decade (p = 0.002) was seen with an increased tendency to conduct the delivery in the operating theatre (p = 0.0025). Rate of caesarean section at full dilatation increased (2% by 2001). Increasing failures of operative vaginal delivery, especially using the ventouse (regression coefficient p = 0.025), and reduced attempts at instrumentation (regression coefficient p = 0.002) were seen.

Disengagement of the deeply engaged fetal head during caesarean section in advanced labor: patwardhan versus push extraction

“…The incidence of CS performed at full dilatation was 5.41% in our study and was comparable to global rates of 4% 19 to 5%. 20 Obstetric confounding parameters like gestatational age, birth weight and the incidence of meconium stained liquor (MSL) were comparable in both the study group.…”

A re‐evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour

“…The most commonly used method for birth when malposition delays delivery is rotational ventouse (RV) . However, the use of RV is four times more likely to fail to deliver the baby when compared with nonrotational ventouse birth .…”

Kielland’s forceps: does it increase the risk of anal sphincter injuries? An observational study

“…Ventouse can be used in these situations as well; however, there is a risk of failure and subsequent use of sequential instruments [1,2] with added maternal and neonatal morbidity. Over the past 20 years the rising trend in the usage of vacuum extractor and more liberal use of caesarean sections have resulted in the steady decline of forceps deliveries [3][4][5]. There are also other factors such as fear of complications and subsequent litigation [6,7], lack of experience with modern obstetric training and increasing obstetrician's preference to resort to caesarean sections in the second stage [8][9][10][11], which has led to the decline in the use of Kielland's forceps.…”