Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London. (11th May 2015)

• Record Type: Journal Article
• Authors: McDonnell, Sian; Chandraharan, Edwin
• Other Names: Wing Deborah A. Academic Editor.
• Is Part Of: Journal of pregnancy. Volume 2015(2015)
• Publication Date: 2015-05-11
• Subjects: Pregnancy -- Periodicals; Pregnancy -- Complications -- Periodicals; Pregnancy; Pregnancy Complications; Pregnancy; Pregnancy -- Complications; Electronic journals; Periodicals; Periodicals; 618.2
• DOI: 10.1155/2015/627810
• Languages: English
• ISSNs: 2090-2727

Abstract

Abstract : Objectives . To review the determinants for a failed operative vaginal delivery and to examine associated fetal and maternal morbidity. Design . Retrospective observational study. Setting . Large London Teaching Hospital. Method . A retrospective review of case notes during a 5-year period was carried out. Results . Overall 119 women (0.44%) out of 26, 856 births had a caesarean section following a failed instrumental delivery, which comprised 5.1% of all operative vaginal births. 73% had a spontaneous onset of labour and 63% required syntocinon at some time prior to delivery. 71.5% of deliveries were complicated by malposition. Only 20% of deliveries were attended by a consultant obstetrician. Almost 50% of women and 8.4% of neonates sustained trauma at the time of either their failed instrumental delivery or the caesarean section. Conclusions . Emergency caesarean section during the second stage of labour is associated with maternal and fetal complications. A 'failed instrumental delivery score' (FIDS) may aid practitioners in predicting an increased likelihood of a failed operative vaginal birth and therefore to consider a trial of operative vaginal delivery in the theatre. Senior input should also be sought because a failed operative vaginal birth is associated with increased maternal and fetal morbidity.