title: Caesarean section at full cervical dilatation.
abstract: BACKGROUND
  Caesarean section at full cervical dilatation has many implications for maternal and neonatal morbidity as well as subsequent pregnancy outcomes. However, increasing trends are reported internationally for second-stage caesarean delivery.
  
  
  OBJECTIVE
  To review the rate and indication for a caesarean section at full dilatation over a 5-year period at a tertiary referral obstetric centre in Sydney.
  
  
  METHODS
  Retrospective cohort review of all women with a singleton, cephalic presenting fetus at ≥37(0)  weeks' gestation delivered by caesarean section in the second stage of labour between 1 January 2009 and 31 December 2013 at Royal Prince Alfred Hospital. Medical records were reviewed, and demographic, maternal and fetal outcome data were obtained. Consultant supervision and documentation standards were recorded. The main outcome measures were the rate of caesarean section at full cervical dilatation, maternal and fetal morbidity.
  
  
  RESULTS
  During the study period, 8449/26063 (32.4%) babies were born by caesarean section. Of these surgical births, 476 (5.6%) were performed at full cervical dilatation at >37 weeks' gestation. There was no observed trend over the 5 years. The majority of women delivered by caesarean section at full dilatation were nulliparous and in spontaneous labour. More than half of these women were delivered without a trial of instrumental delivery. Consultant obstetricians were present for 7% of public second-stage caesarean deliveries.
  
  
  CONCLUSIONS
  We report a 5-year experience with caesarean delivery at full dilatation at a tertiary unit. The rate was variable over the 5 years. Secondary outcome measures suggest that consultant supervision is uncommon and documentation standards require improvement.
authors.affiliation: Department of Women's Health and Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Georgina
authors.initials: G
authors.lastname: Davis
authors.affiliation: Department of Women's Health and Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.|Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Fleming
authors.affiliation: Department of Women's Health and Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Keryn
authors.initials: K
authors.lastname: Ford
authors.affiliation: Department of Women's Health and Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Marie Rose
authors.initials: MR
authors.lastname: Mouawad
authors.affiliation: Department of Women's Health and Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.|University of Sydney, Australia.|Ultrasound Care Sydney, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Ludlow
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D004282:Documentation / Q000592:standards; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007748:Labor Stage, Second; D009774:Obstetrics / Q000458:organization & administration*; D010298:Parity; D010348:Patient Care Team / Q000458:organization & administration*; D011247:Pregnancy; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
keywords: caesarean section; full dilatation; instrumental delivery; second stage of labour