SAFE REDUCTION OF CESAREAN SECTION RATE IN THE SECOND STAGE OF LABOR – POSSIBLE SOLUTIONS

Authors

  • Sergei Slavov University Obstetrics and Gynecology Hospital “Maichin dom”- Sofia, Bulgaria, Department of Obstetrics and Gynecology, Medical University, Sofia, Bulgaria

Keywords:

CTG, Operative vaginal delivery, Cesarean section

Abstract

Cesarean section is the most commonly performed operation in the world with an ever-increasing frequency. Among the most common indications for cesarean section are abnormalities of pelvis leading to feto-pelvic disproportion during labor, placenta previa, placental abruption, preeclampsia, concomitant diseases of the mother, as well as fetal conditions leading to distress, malpresentation of the fetus, etc. Despite the definite benefits it brings to the mother and fetus, there are a number of early and late complications that worsen obstetric results in women who have given birth by cesarean section. There is evidence that the incidence of cesarean sections is higher than optimal and continues to increase. Often a cesarean section is performed due to relative indications and in a large number of cases a safe vaginal birth is possible. The proportion of emergency cesarean sections performed in the second period of labor is not small. This necessitates a review of obstetric behavior, in particular the usage of operative vaginal delivery (OVD) and cardiotocographic (CTG) monitoring of the fetus in the second period of labor. In contrast to the ever-increasing incidence of cesarean section, the incidence of operative vaginal delivery with both vacuum extractor and forceps has decreased significantly in recent years. This trend is to the detriment of obstetric practice as OVD in the hands of an experienced obstetrician is a safe alternative to cesarean section during vaginal birth. Abnormalities in the fetal heart rate(FHR) is the second most common indication for all cesarean sections. It is estimated that between 65% and 85% of all births at some point have a category II FHR that include bradycardia with variability, tachycardia, minimal variability, no variability with no recurrent decelerations, marked variability, absence of induced accelerations even after fetal stimulation, recurrent variable decelerations with minimal or moderate baseline variability, prolonged decelerations lasting more than two minutes, but less than ten minutes, recurrent late decelerations with moderate variability, variable decelerations with other characteristics such as slow return to baseline, overshooting the baseline, or 'shoulders'. A clear approach in these cases is paramount to the outcome of the labor. Knowledge and proper management of operative vaginal birth by vacuum extractor or forceps, as well as the correct interpretation of CTG patterns can significantly reduce the frequency of cesarean sections during labor without adversely affecting the condition of the mother or newborn. These methods should be mastered as much as possible during the specializations in obstetrics and gynecology in order to improve the outcome of a normal labor and reduce the frequency of cesarean section in the future.

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Published

2021-08-16

How to Cite

Slavov, S. (2021). SAFE REDUCTION OF CESAREAN SECTION RATE IN THE SECOND STAGE OF LABOR – POSSIBLE SOLUTIONS. KNOWLEDGE - International Journal , 47(4), 575–578. Retrieved from http://ikm.mk/ojs/index.php/kij/article/view/4821