Association between rates of second-stage Caesarean section and instrumental delivery

Wai-Hang CHUNG; Yan-Yu LI; Choi-Wah KONG; William Wing-Kee TO

doi:10.12809/hkjgom.19.2.02

Authors

Wai-Hang CHUNG
Yan-Yu LI
Choi-Wah KONG
William Wing-Kee TO

DOI:

https://doi.org/10.12809/hkjgom.19.2.02

Keywords:

Cesarean section, Delivery, obstetric, Labour stage, second

Abstract

Objective: The increasing Caesarean section (CS) rate is a global public health concern, as is the second-stage CS rate at full cervical dilatation. This study aimed to study the temporal trends of the increased second-stage CS rate and the reduced instrumental delivery rate in a regional obstetric unit over 20 years.
Methods: Records of all CS and instrumental deliveries in a single obstetric unit between 1997 and 2016 were reviewed. Data were stratified into five 4-year intervals to analyse any significant trends.
Results: During the study period, there were a total of 87 413 deliveries, with 17 600 (20.1%) CS and 6502 (7.4%) instrumental deliveries. Although the overall CS rate increased modestly from 15.8% in 2001 to 24.6% in 2014, the rise in second-stage CS was significant (p<0.001) and culminated at 7.33% of all emergency CS in 2005-2008. Simultaneous to this increase was a trough in instrumental delivery rate of 5.3% (p<0.001) and a high failed instrumental delivery rate of 9.37% (p<0.001).
Conclusion: The increase in the second-stage CS rate was related to reluctance to attempt instrumental delivery together with failure of instrumental delivery. Introduction of training requirement in forceps delivery by Hong Kong College of Obstetricians and Gynaecologists resulted in an increasing use of forceps.

References

Betran AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One 2016;11:e0148343.

Chung WH, Kong CW, To WW. Secular trends in caesarean section rates over 20 years in a regional obstetric unit in Hong Kong. Hong Kong Med J 2017;23:340-8.

Thomas J, ParanjothyS. RCOG Clinical Effectiveness Support Unit. London: The national sentinel caesarean section audit. RCOG Press; 2001.

Loudon JA, Groom KM, Hinkson L, Harrington D, Paterson-Brown S. Changing trends in operative delivery performed at full dilatation over a 10-year period. J Obstet Gynaecol 2010;30:370-5.

Wood SL, Tang S, Crawford S. Cesarean delivery in the second stage of labor and the risk of subsequent premature birth. Am J Obstet Gynecol 2017;217:63.e-1-63.

McDonnell S, Chandraharan E. Determinants and outcomes of emergency caesarean section following failed instrumental delivery: 5-year observational review at a tertiary referral centre in London. J Pregnancy 2015;2015:627810.

Pergialiotis V, Vlachos DG, Rodolakis A, Haidopoulos D, Thomakos N, Vlachos GD. First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014;175:15-24.

Unterscheider J, McMenamin M, Cullinane F. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynecol Reprod Biol 2011;157:141-4.

Royal College of Obstetricians and Gynaecologist. Operative vaginal delivery. Green-top guideline No. 26. London: RCOG; 2011.

Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study. BMC Pregnancy Childbirth 2011;11:8.

Vousden N, Hamakarim Z, Briley A, et al. Assessment of a full dilatation cesarean delivery simulator. Obstet Gynecol 2015;125:369-74.

Merriam AA, Ananth CV, Wright JD, Siddiq Z, D’Alton ME, Friedman AM. Trends in operative vaginal delivery, 2005-2013: a population-based study. BJOG 2017;124:1365-72.

Bahl R, Strachan B, Murphy DJ. Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study. BMJ 2004;328:311.

World Health Organization, United Nations Population Fund, UNICEF & Mailman School of Public Health. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization; 2009.

American College of Obstetricians Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014;123:693-711.

The logbook for structured training at the Hong Kong College of Obstetricians and Gynaecologists 2008. Available from: http://www.hkcog.org.hk/hkcog/pages_2_156.html. Accessed 16 April 2018.

O’Mahony F, Hofmeyr GJ, Menon V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev 2010;11:CD005455.

Olah KS. Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment. J Obstet Gynaecol 2005;25:115-6.

Barbera AF, Pombar X, Perugino G, Lezotte DC, Hobbins JC. A new method to assess fetal head descent in labor with transperineal ultrasound. Ultrasound Obstet Gynecol 2009;33:313-9.

Ghi T, Youssef A, Maroni E, et al. Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery. Ultrasound Obstet Gynecol 2013;41:430-5.

Kalache KD, Duckelmann AM, Michaelis SA, Lange J, Cichon G, Dudenhausen JW. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery? Ultrasound Obstet Gynecol 2009;33:326-30.

Shaffer BL, Cheng YW, Vargas JE, Laros RK Jr, Caughey AB. Manual rotation of the fetal occiput: predictors of success and

delivery. Am J Obstet Gynecol 2006;194:e7-9.

Majoko F, Gardener G. Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database Syst Rev 2012;10:CD005545.

Bailit JL, Grobman WA, Rice MM, et al. Evaluation of delivery options for second-stage events. Am J Obstet Gynecol 2016;214:638.e1-638.e10.

Halscott TL, Reddy UM, Landy HJ, et al. Maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor. Obstet Gynecol 2015;126:1265-72.

Murphy DJ, Liebling RE, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet 2001;358:1203-7.

Peleg D, Perlitz Y, Pansky S, Levit A, Ben-Ami M. Accidental delivery through a vaginal incision (laparoelytotomy) during caesarean section in the second stage of labour. BJOG 2001;108:659-60.

Manning JB, Tolcher MC, Chandraharan E, Rose CH. Delivery of an impacted fetal head during cesarean: a literature review and proposed management algorithm. Obstet Gynecol Surv 2015;70:719-24.

Cong A, de Vries B, Ludlow J. Does previous caesarean section at full dilatation increase the likelihood of subsequent spontaneous preterm birth? Aust N Z J Obstet Gynaecol 2018;58:267-73.

Tempest N, Hart A, Walkinshaw S, Hapangama DK. A reevaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour. BJOG 2013;120:1277-84.