Caesarean delivery in the second stage of labour

doi:10.1136/bmj.38971.466979.DE

BMJ 2006;333:613-614 (23 September), doi:10.1136/bmj.38971.466979.DE

Editorial

Caesarean delivery in the second stage of labour

Better training in instrumental delivery may reduce rates

The first 150 words of the full text of this article appear below.

Despite much discussion of the increase in elective caesareanrates over the past 20 years,¹ ^w1 little attention has beenpaid to the rise in second stage caesarean section rates. Thematernal risks of second stage caesareans include major haemorrhage,longer hospital stay, greater risk of bladder trauma, and extensiontears of the uterine angle leading to broad ligament haematoma.²Although second stage caesarean section is sometimes appropriate,many could be prevented by the attendance of a more skilledobstetrician.

Currently, obstetric trainees perform most of the second stagetrials of instrumental delivery. A recent UK study found thatdecisions made by consultant obstetric staff are important indetermining whether a second stage caesarean section is theoptimum method of delivery for women with delay in advancedlabour.³ The investigators found substantial differences betweenconsultants' and specialist registrars' opinions on factorsaffecting safe vaginal delivery—such as position of thefetal . . . [Full text of this article]

Chris Spencer, consultant obstetrician

St John's Hospital, Chelmsford, Essex CM2 9BG

Deirdre Murphy, professor

Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Coombe Women's Hospital, Dublin, Republic of Ireland

Susan Bewley, consultant obstetrician

Women's Services, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH
(susan.bewley@gstt.nhs.uk)

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