Maternal Determinants in Full Dilatation Caesarean Section (FDCS): A Prospective Study in Tertiary Teaching Hospital in North Kerala

Abstract

Background: Caesarean section (CS) is the most commonly performed abdominal operation in women in both industrialised and low-income
countries. CS at full cervical dilatation is a technically more challenging procedure than CS in early labour. Material and Methods:This
prospective case- control study was conducted at a tertiary care teaching institute from Aug 1 2019 to July 31 2020. It included all women (N = 90)
delivered by caesarean section. There were 103 caesareans out of which 37 were FDCS and 66 were first stage caesareans. Maternal variables
included age of the mother, maternal weight, obstetric score, spontaneous or induced labour and analysed the indications of primary caesarean.
The duration of surgery was defined as the time elapsed between skin incision and skin closure and measured.Results:Primigravidae constituted
73% in second stage caesareans and 47% of in first stage caesarean and hence a significant determinant of FDCS. Maternal and foetal weight
significantly increased FDCS rates. Mean gestational age was 39.08 and 38.72 weeks in second stage and first stage group and it was comparable.
We found that mean operative time was 18.4 minutes longer for FDCS when compared to first stage CS. Arrest of descent due to cephalopelvic
disproportion was the most common indication in FDCS (25.2%) followed by malposition, NRFHR and Failed vacuum. Patwardhan method
followed by pushing from below and breech extraction were methods adopted to deliver the impacted foetus.Conclusion: Decision making in
second stage caesarean section is often challenging and involvement of senior obstetrician is desired for decision making and for performing second
stage CS. Special attention should be provided to the patients undergoing FDCS.