Full Dilatation Caesarean Section Research Articles

Perinatal and neonatal outcomes of high-risk asymptomatic women from a specialist preterm birth surveillance clinic

ObjectivesTo report the perinatal outcomes of high-risk asymptomatic women who attended a specialist preterm surveillance clinic (PSC) to undergo screening for spontaneous preterm birth (PTB) in Ireland. MethodsSingle center, retrospective cohort study of asymptomatic high risk women who attended the PSC between January 2019 and December 2022. A comprehensive database of all patients who attended the clinic during the study period was constructed and analyzed. Overall outcomes were reported, and stratified per the occurrence of preterm or term birth. Iatrogenic PTBs were included in the outcome data. ResultsFollowing exclusions for loss-to-follow-up, 762 cases were analyzed, constituting 2262 PSC visits. Of those, 183 women were prescribed progesterone (24.0 %), and 100 women underwent cervical cerclage (13.1 %) to prevent spontaneous PTB. Overall, 2.4 %, 6.2 % and 18.6 % of participants gave birth prior to 30 weeks, 34 weeks, and 37 weeks, respectively. The median gestational age at birth for the entire cohort was 38.6 weeks (inter-quartile range (IQR) 37.2–39.6 weeks).Women who delivered < 37 weeks were significantly more likely to be smokers (p = 0.030), have a previous spontaneous PTB (p = 0.016), have multiple pregnancies (p < 0.001), type 1 or 2 diabetes (p = 0.044), or have a previous full dilatation caesarean section birth (p = 0.024). Infants born prior to 37 weeks were more likely to have a lower median birthweight (2270 vs 3300 g, p < 0.001), be admitted to a neonatal intensive care unit (53.8 % vs 2.3 %, p < 0.001) or experience short-term morbidity, including respiratory support (38.0 % vs 1.6 %, p < 0.001). ConclusionsOver 80% of women deemed to be at high risk of PTB gave birth at term gestations following attendance at a PSC during pregnancy. Most women can be successfully managed without interventions, instead employing a policy of serial cervical surveillance, to identify those at greatest risk of PTB.

VP46.20: A rarely identified case: cervical incompetence with a history of full dilatation Caesarean section causing repeated preterm birth

VP46.20: A rarely identified case: cervical incompetence with a history of full dilatation Caesarean section causing repeated preterm birth

Full Dilatation Caesarean Section and the Risk of Preterm Delivery in a Subsequent Pregnancy: A Historical Cohort Study.

Full dilatation caesarean sections (CS) have increased risk of uterine extensions, which leads to cervical trauma that has been associated with an increased risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. The aim of this study was to determine if CS at full dilatation increased the risk of sPTB in a subsequent pregnancy in our unit. A historical cohort study was performed on women delivered by emergency CS between 2008–2015 (n = 5808) in a university hospital who had a subsequent pregnancy in this time frame (n = 1557). Women were classified into two exposure groups; those who were 6–9 cm and those fully dilated at index CS. The reference group was CS at 0–5 cm dilated. The primary outcome was sPTB < 37 weeks’ gestation. CS at 6–9 cm or fully dilated did not significantly increase the odds of sPTB in a subsequent pregnancy (aOR 1.64, 95% CI: 0.83–3.28, p = 0.158; aOR 1.86, 95% CI: 0.91–3.83; p = 0.090, respectively). However, a short interpregnancy interval of <1 year significantly increased the odds of sPTB in a subsequent pregnancy (aOR 3.10, 95% CI: 1.71–5.61). This study has found a short interpregnancy interval following a CS conferred a higher risk of sPTB than full dilatation CS. This finding highlights postnatal contraception and increased surveillance of women with short interpregnancy interval post CS as possible interventions to reduce sPTB.

CRAFT (Cerclage after full dilatation caesarean section): protocol of a mixed methods study investigating the role of previous in-labour caesarean section in preterm birth risk

BackgroundFull dilatation caesarean sections are associated with recurrent early spontaneous preterm birth and late miscarriage. The risk following first stage caesarean sections, are less well defined, but appears to be increased in late-first stage of labour. The mechanism for this increased risk of late miscarriage and early spontaneous preterm birth in these women is unknown and there are uncertainties with regards to clinical management. Current predictive models of preterm birth (based on transvaginal ultrasound and quantitative fetal fibronectin) have not been validated in these women and it is unknown whether the threshold to define a short cervix (≤25 mm) is reliable in predicting the risk of preterm birth. In addition the efficacy of standard treatments or whether benefit may be derived from prophylactic interventions such as a cervical cerclage is unknown.MethodsThere are three distinct components to the CRAFT project (CRAFT-OBS, CRAFT-RCT and CRAFT-IMG).CRAFT-OBS: Observational Study; To evaluate subsequent pregnancy risk of preterm birth in women with a prior caesarean section in established labour. This prospective study of cervical length and quantitative fetal fibronectin data will establish a predictive model of preterm birth.CRAFT-RCT: Randomised controlled trial arm; To assess treatment for short cervix in women at high risk of preterm birth following a fully dilated caesarean section.CRAFT-IMG: Imaging sub-study; To evaluate the use of MRI and transvaginal ultrasound imaging of micro and macrostructural cervical features which may predispose to preterm birth in women with a previous fully dilated caesarean section, such as scar position and niche.DiscussionThe CRAFT project will quantify the risk of preterm birth or late miscarriage in women with previous in-labour caesarean section, define the best management and shed light on pathological mechanisms so as to improve the care we offer to women and their babies.Trial registrationCRAFT was prospectively registered on 25th November 2019 with the ISRCTN registry (https://doi.org/10.1186/ISRCTN15068651).

VP52.15: Caesarean section (CS) scar location and preterm birth following full dilatation CS

VP52.15: Caesarean section (CS) scar location and preterm birth following full dilatation CS

Cerclage After Full Dilatation Caesarean Section

Cerclage After Full Dilatation Caesarean Section

Exploring full cervical dilatation caesarean sections–A retrospective cohort study

BackgroundThe rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally. ObjectivesThe objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences. Study designRetrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit’s electronic database for 2015. ResultsThe rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80–5.33 kg) vs 3.48 kg (1.53–4.40 kg)). There was no difference in neonatal morbidity. ConclusionFetal head malposition is associated with a higher risk of full dilatation caesarean section. Interestingly, maternal and fetal morbidity were similar between full dilatation caesarean sections and anticipated difficult operative vaginal deliveries carried out in theatre. The management of labour in terms of the decision to use oxytocin judiciously in hope of correcting inefficient uterine contractions and continuous labour ward training, particularly the diagnosis of malposition and its correction may be beneficial in reducing the rate of full dilation caesarean sections.

Perinatal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Perinatal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Maternal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Maternal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Caesarean section at full dilatation: incidence, impact and current management

Key content The incidence of caesarean sections performed at full dilatation is increasing, and may now represent around 8000 deliveries in the UK each year. Delivery can be technically challenging due to fetal impaction into the pelvis, and may be associated with greater maternal and fetal morbidity even without failed attempt at vaginal delivery. Guidelines are needed to define optimal management, including the use of new devices to teach or assist safe delivery. Best practice should be incorporated into structured training programmes such as Managing Obstetric Emergencies and Trauma (MOET). Learning objectives Assess the reasons for the increasing incidence of full dilatation caesarean section at full dilatation. Describe the associated maternal and neonatal risks compared with operative vaginal delivery. Describe the current evidence for optimal management and define areas for research. Ethical issues Further research is needed to define long‐term morbidity and address the risk/benefit of second‐stage caesarean section at full dilatation versus attempted vaginal delivery.

PPO.55 Full dilatation caesarean section and risk of subsequent preterm birth: a case series

Preterm birth (PTB) or mid-trimester loss is rare following term pregnancy. Caesarean section carried out at full dilatation (FDCS) is associated with increased clinical challenges1. The integrity of the cervix...

Does elevating the fetal head prior to delivery using a fetal pillow reduce maternal and fetal complications in a full dilatation caesarean section? A prospective study with historical controls

A caesarean section at full dilatation (CSFD) can be technically demanding and has consistent association with increased intraoperative trauma. There is evidence that the incidence of caesarean sections at full dilation is on the rise. We report on a prospective study of 50 women undergoing CSFD using a fetal pillow (FP) to elevate the fetal head. Data were compared with historical controls of 124 women without FP use on uterine extensions, uterine incision delivery interval, blood loss, need for transfusion, operating time, length of stay, intensive care unit admission. The FP elevated the fetal head in all 50 women (p < 0.001). We found that patients in the FP group had a lower incidence of extensions (p = 0.03), shorter operating time (p < 0.001), uterine incision to delivery interval (p < 0.001) and shorter length of hospital stay (p < 0.001). Blood loss > 1,000 ml and admission to ICU was also lower but were not statistically significant. There were no significant differences in the fetal complications studied, APGAR scores, admission to neonatal intensive care unit, seizures, neonatal injury or death.

PL.09 Second-Stage Caesarean Sections: How to Deliver and How to Train?

Background Approximately 8000 full dilatation caesarean sections (CS) are performed in the UK each year1. Delivery can be technically challenging and associated with greater maternal and fetal morbidity1. There are...

A temporary inferior vena caval filter: the way forward in prophylaxis against pulmonary embolism?

The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally.The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences.Retrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit’s electronic database for 2015.The rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80–5.33 kg) vs 3.48 kg (1.53–4.40 kg)). There was no difference in neonatal morbidity.Fetal head malposition is associated with a higher risk of full dilatation caesarean section. Interestingly, maternal and fetal morbidity were similar between full dilatation caesarean sections and anticipated difficult operative vaginal deliveries carried out in theatre. The management of labour in terms of the decision to use oxytocin judiciously in hope of correcting inefficient uterine contractions and continuous labour ward training, particularly the diagnosis of malposition and its correction may be beneficial in reducing the rate of full dilation caesarean sections.