Abstract
Introduction: Operative delivery at full cervical dilatation can be either a caesarean section or instrumental deliveries. Instrumental deliveries are well debated options for reducing caesarean section rates but they have their own set of maternal and fetal morbidities. CS at full dilatation of cervix is also demanding due to impacted fetal head. Choice between the two depends on the treating obstetrician. 
 Objective: To assess perinatal morbidities between vacuum delivery and caesarean section at full cervical dilatation. 
 Methodology: This is an observational cross-sectional comparative study done for the duration of one year from January to December 2019. Women undergoing vacuum delivery or caesarean section in full cervical dilatation were compared for maternal and neonatal morbidities. Risk factors associated with these morbidities were also assessed. The morbidities in each group were compared using Pearson's chi square test. Likelihood of morbidities in relation to risk factors was calculated using univariate logistic regression. 
 Results: Prevalence of maternal complications in vacuum delivery was 33.3% (28) and in caesarean was 42.9% (15). Neonatal complications in vacuum delivery was 50% (42) and in caesarean was 48.6% (17). Being a referred case (OR=1.14) and a primigravida (OR=1.45) were risk factors for perinatal morbidities in vacuum delivery. Referred cases (OR=1.52), primigravidas (OR=5.90), head station lower than zero (OR=1.26) and birth weight of more than 3500 gms (OR=2.60) were associated with more number of morbidities in caesarean at full cervical dilatation.
 Conclusion Operative deliveries at full cervical dilatation, either vacuum or CS carry risk of maternal and neonatal morbidities. Obstetrician should make a decision keeping in mind certain risk factors like referred cases, parity, head station, number of pulls, method of delivery of head and fetal weight so that severe morbidities can be prevented.
Highlights
Opera ve delivery at full cervical dilata on can be either a Caesarean Sec on (CS) or instrumental deliveries known as opera ve vaginal deliveries
Obstetrician should make a decision keeping in mind certain risk factors like referred cases, parity, head sta on, number of pulls, method of delivery of head and fetal weight so that severe morbidi es can be prevented
Women with a term (37-42 weeks), singleton pregnancy with cephalic presenta on, in second stage of labor, who were decided by the obstetrician on duty to undergo vacuum delivery (VD) or CSFD were enrolled in the study
Summary
Opera ve delivery at full cervical dilata on can be either a Caesarean Sec on (CS) or instrumental deliveries known as opera ve vaginal deliveries. Instrumental deliveries, either vacuum or forceps delivery, are well debated op ons for reducing CS rates with an incidence of 1% of all ins tu onal deliveries in low and middle income countries,[1] but they have their own set of maternal and fetal morbidi es like perineal tear, postpartum haemorrhage, (PPH) neonatal trauma and admission to neonatal unit.[2,3] On the other hand, performing CS at full dilata on of cervix is demanding due to impacted fetal head with increased risk of PPH, extension of uterine incision and urinary bladder injury, febrile illness and wound infec on.[4,5,6] Despite these risks, the rate of Caesarean Sec on at Full Cervical Dilata on (CSFD) has increased from 1 to 5% over the past decades.[5] In condi ons where labor progresses upto the second stage but normal delivery seems life threatening to the mother or the baby, choice needs to be made between opera ve vaginal delivery or CSFD. This is a choice obstetricians have to make between the lesser of two evils
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