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Rising rate of second stage C-section: who is to blame? A questionnaire based study of trainees in the North East of England
  1. L Gurney,
  2. N Shivanath,
  3. BO Ononeze
  1. Darlington Memorial Hospital, Darlington, UK

Abstract

Second stage Caesarean section as a result of failed operative delivery is increasing. This may partly be due to inadequate training and wrong choice of instrument. Our aim was to use questionnaire survey to ascertain the choice of instruments used by trainees in second stage. Of the 63 questionnaires sent out, 50 trainees replied, given a response rate of 77%.

62% would use forceps if there is fetal distress and the vertex is below the spine and the reason was because it was likely to succeed. 38% preferred vacuum extractor because that was what they usually use. When asked which instrument they would use in delayed second stage in spite of good maternal effort (vertex occipitat anterior and below spine), 42% would use forceps and the reason was because it was likely to succeed than vacuum. 40% would use vacuum and the reason again was because it was what they usually use. 96% of trainees agreed that wrong choice of instrument may lead to failure and hence Caesarean section. 42% agreed that further training in operative delivery with emphasis on determination of vertex position and supervision will help them to choose instruments appropriate to the clinical circumstances.

Conclusion Proper selection of instrument is the key to successful vaginal delivery. Some trainees' choice of instruments was not based on what was most appropriate to the clinical circumstances but rather on what they were used to. This is a relevant evaluation finding and should be used to improve training in instrumental delivery.

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