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

Wai-Hang CHUNG, Yan-Yu LI, William Wing-Kee TO
Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong

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.

Hong Kong J Gynaecol Obstet Midwifery 2019; 19(2):89–95
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