Caesarean section in second stage of labour: a commentary on principles and techniques

Michael S. Archibong, Wilson S. Adenikinju, Olaniyi J. Olayemi, Mariam Amuda


Caesarean section done at full cervical dilatation (second stage of labour) has been on the rise globally and comes with its own unique challenges and complications. This commentary highlights the peculiar challenges associated with caesarean section in second stage of labour and gives an overview on various principles to be followed and techniques to employ to reduce fetal and maternal morbidity.


Second stage, Caesarean section, Impacted head

Full Text:



Unterscheider J, McMenamin M, Cullinane F. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynecol Reprod Biol. 2011;157:141-4.

Asicioglu O, Gungorduk K, Yildirim G, Asicioglu BB, Gungorduk OC, Ark C et al. Second-stage vs first-stage caesarean delivery: comparison of maternal and perinatal outcomes. J Obstet Gynaecol. 2014;34:598-604.

Peleg D, Perlitz Y, Pansky S, Levit A, Ben Ami M. Accidental delivery through a vaginal incision (laparoelytrotomy) during caesarean section in the second stage of labour. BJOG. 2001;108:659 60.

Vousden N, Cargill Z, Briley A, Tydeman G, Shennan AH. Caesarean section at full dilatation: incidence, impact and current management. Obstetric Gynaecol. 2014;16:199-205.

Taingson MC, Adze JA, Bature SB, Amina DM, Caleb M, Amina A et al. Post-caesarean vesicouterine fistula: Youssef's syndrome-A case report. Arch Int Surg. 2017;7:132-4.

Pergialiotis V, Mitsopoulou D, Biliou E, Bellos I, Karagiannis V, Papapanagiotou A et al. Cephalad-caudad versus transverse blunt expansion of the low transverse hysterotomy during cesarean delivery decreases maternal morbidity: a meta-analysis. Am J Obstet Gynecol. 2021;21:S0002-9378(21)00461-0.

Jeve YB, Navti OB, Konje JC. Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis. BJOG. 2016;123:222.

Waterfall H, Grivell RM, Dodd JM. Techniques for assisting difficult delivery at caesarean section. Cochrane Database Syst Rev. 2016;1:CD004944.

Bhattacharya R, Ramesh AC. Cesarean Section of an Impacted Fetal Head at Full Cervical Dilatation- Evaluation of Patwardhan Technique. Crit Care Obst Gyne. 2020;6(4):9.

Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation. Int J Gynaecol Obstet. 2016;133:178-82.

Clinical Innovations. Murray Utah. C-snorkel: Impacted Fetal Head Release Device by Softlift. 2012. Available at: Accessed on 20 April 2020.

Olah KS. Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment. J Obstet Gynaecol. 2005;25:115-6.