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.

Reference

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.