Chapter 7 - Caesarean section at full dilatation

Summary

This chapter talks about the possible maternal and fetal complications associated with the second-stage caesarean sections at full dilatation. Maternal factors that predispose to cephalopelvic disproportion (CPD) include contracted pelvis, pelvic exostoses and spondylolisthesis. Predisposing fetal factors include hydrocephalus, large infant, brow presentation, face presentation (mento-posterior), occipito-posterior (OP) position and deflexed head. The chapter describes the surgical techniques to perform safer second-stage caesarean sections. The Pfannenstiel incision was introduced in 1900 and is widely used for caesarean section. It has excellent cosmetic results and a low incidence of wound breakdown and allows for early ambulation. Careful identification of the ureters and bladder is essential, and there should always be a high index of suspicion in such situations. Methylene blue dye can be injected into the bladder via the urinary catheter to identify any leakage. The chapter describes the prevention of complications of second-stage caesarean section.