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Risks increase with c-section at full cervical dilatation.(Obstetrics)
EDMONTON, ALTA. -- Maternal intraoperative trauma and perinatal asphyxia were significantly more common in nulliparous women who underwent cesarean delivery at full cervical dilatation, compared with those who had cesareans before they were fully dilated, a Canadian study revealed.
Victoria M. Allen, M.D., and her associates at Dalhousie University, Halifax, used the Nova Scotia Atlee Perinatal Database to track a host of outcome measures in more than 1,600 term deliveries by nulliparous women requiring cesarean deliveries during labor during a 6-year period. She reported the findings at the annual meeting of the Society of Obstetricians and Gynaecologists of Canada.
Dystocia was the primary reason for cesarean delivery in 84% of the 549 patients who delivered at full dilatation, compared with 71% of patients whose labor had not progressed that far. Fetal distress was the second leading cause, accounting for 24% of deliveries performed short of full dilatation and 12% of deliveries in patients fully dilated.
Fully dilated patients were nearly five times more likely to experience intraoperative trauma, and their neonates were 1.4 times as likely to suffer asphyxia as those of patients who had cesareans earlier in the course of labor. Both differences were statistically significant (P
The risk of maternal trauma was further heightened with prolongation of the second stage of labor, Dr. Allen reported.
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...of the fetal head in the maternal pelvis during the second stage of labor. Chou and colleagues studied 88 patients after full dilatation. One clinician was asked to determine the position of the fetal head digitally, and another blinded examiner, using transabdominal...
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...woman was directed to push for at least 45 minutes prior to full dilatation, a progression that is contraindicated by incomplete dilatation...baby's deteriorating fetal heart rate, the absence of full dilatation, and a persistent, irritable and hyperstimulated uterus...
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...that initiating maternal pushing prior to complete cervical dilatation is a bad idea. However, it seems that attaining full dilatation now represents an immediate license to push. Although the idea behind this practice has been to shorten the second stage...
- CME objectives/questions.
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...the rotations were successful. *Virtually all of the patients had epidurals. *Only 20% of rotations were done before full dilatation *The Apgar scores were lower in those having a rotation. Manual rotation can: *potentially diminish maternal morbidity...
Source: HighBeam Research, Risks increase with c-section at full cervical dilatation.(Obstetrics)