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

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Abstract
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.

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