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PL.09 Second-Stage Caesarean Sections: How to Deliver and How to Train?
  1. N Vousden,
  2. A Briley,
  3. G Tydeman,
  4. Z Hamakarim,
  5. P Seed,
  6. AH Shennan
  1. Division of Womens Health, Kings College London, Academic Womens Health Centre, Kings Health Partners, London, UK


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 no national guidelines. The aim of this study is to determine expert consensus on the most important techniques for safe delivery and to validate a second-stage CS simulation device (‘Desperate Debra’).

Method Results of questionnaires were independently analysed by two people. Specialists performed three deliveries with different fetal positions and degrees of impaction on a second-stage CS simulator and completed visual analogue scores (VAS).

Results Responses were received from 47 specialists (>7 years experience) with a mean 18 years of labour-ward experience. The five most reported important techniques for safe delivery were 1)high uterine incision (n = 28), 2)assistance to push fetal head transvaginally (n = 25), 3)correct flexion of fetal head (n = 20), 4)determine fetal position prior to starting (n = 17) and 5)disempaction of the fetal head in the caudal direction prior to elevation (n = 13). The training scenarios were performed by 30 specialists (mean 7 years experience). The degrees of impaction (1.light, 2.moderate, 3.severe) correlated with perceived difficulty of delivery (mean VAS 29/100, 42/100 and 88/100 respectively; 1–2 vs. 3 linear regression p < 0.001). Delivery was successful in 100%, 90% and 61% respectively (1–2 vs. 3 binomial regression p < 0.05). 87% of specialists found it realistic and 93% useful.

Conclusions The simulator device is a valuable training resource. It should be used in conjugation with currently accepted techniques while further research on optimal management is awaited.


  1. Loudon JAZ, Groom KM, Hinkson L, Harrington D & Paterson-Brown S. Changing trends in operative delivery performed at full dilatation over a 10-year period. Journal of Obstetrics and Gynaecology 2010;30:370–375.

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