Introduction Attention has focused recently on improving trainee's skills at operative vaginal delivery to reduce the number of Caesarean sections in the second stage of labour. There are limited data available to guide the obstetrician when faced with the choice between a potentially difficult operative vaginal delivery and the risks of a full dilatation Caesarean section.
Methods A retrospective review of all term, singleton, cephalic deliveries carried out at full dilatation in theatre between the 1 August 2007 and the 31 July 2008 was performed.
Results During the period 144 women were identified; 72 (50%) women had a MCFD, 44 (30.5%) women had a rotational forceps delivery and 28 (19.4%) women had a Caesarean section at full dilatation. Operative delivery in the second stage of labour represented 5.3% of all deliveries within our unit.
Of those women delivered by Caesarean section, a prior attempt at vaginal delivery was performed in 7 (24%). Median blood loss was 700 ml in the Caesarean section group vs 400 ml in the forceps group (p<0.001).
A consultant or Specialist Registrar 5 was present at all cases when a vaginal delivery was attempted. In women who had an immediate Caesarean section, a consultant was not present at five cases (25%).
Conclusion Vaginal delivery is associated with reduced morbidity for the mother. Senior attendance at all operative deliveries at full dilatation in theatre appears to reduce the number of Caesarean sections performed.
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