Second Stage Caesarean Section
Second Stage Caesarean Section (CS) occurs in around 2% of all births and recent data suggests that it is on the rise(1). There is irrefutable evidence that CS carried out at or near full dilation of the cervix leads to higher complications for the mother and her baby(2). All these complications are due to various degrees of difficulty encountered in the delivery of the engaged fetal head.
An assistant pushing from below is the most commonly used technique when difficulty is encountered during delivery at a CS. Other methods are described but these are difficult to perform and teach, often leading to other complications.
I also believe that the degree of difficulty encountered during the delivery of the head is not always possible to predict but is most likely to occur in advanced labour with a deeply engaged head or when an attempt at an instrumental delivery has been made. The cases discussed raise questions about the techniques that were used. A simple solution available to us is Fetal Pillow, an easy to use and effective device. The use of this device has been increasing since the recent publication of a RCT, Australia study and a case controlled study and provides a safer alternative to relying on manual techniques. Find out more here.
Dr R Varma
Consultant Obstetrician & Gynaecologist
About the author
Dr Varma is a consultant Obstetrician & Gynaecologist with 35 years’ experience in the field of O&G. He is the inventor of fetal pillow and a part time Medical Director of Safe Obstetric Systems. He is still in active clinical practice in the field of Urogynaecology.
- Unterscheider J, McMenamin M, Cullinane F. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynaecol Reprod Biol 2011;157:1414.
- Pergialiotis V, Vlachos, D G, Rodolakis A, Haidopoulos D, Thomakos N, Vlachos G D., First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis, European Journal of Obstetrics & Gynecology and Reproductive Biology 175 (2014) 1524
- Danylyshyn-Adams K, Young E, Crnosija N. Time from Uterine incision to delivery in cesarean deliveries and associated neonatal outcomes. Proceedings of American College of Obstetricians & Gynaecology annual conference (221) May 2016.