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Objectives . To review the determinants for a failed operative vaginal delivery and to examine associated fetal and maternal morbidity.  Design . Retrospective observational study.  Setting . Large London Teaching Hospital.  Method . A retrospective review of case notes during a 5-year period was carried out.  Results . Overall 119 women (0.44%) out of 26,856 births had a caesarean section following a failed instrumental delivery, which comprised 5.1% of all operative vaginal births. 73% had a spontaneous onset of labour and 63% required syntocinon at some time prior to delivery. 71.5% of deliveries were complicated by malposition. Only 20% of deliveries were attended by a consultant obstetrician. Almost 50% of women and 8.4% of neonates sustained trauma at the time of either their failed instrumental delivery or the caesarean section.  Conclusions . Emergency caesarean section during the second stage of labour is associated with maternal and fetal complications. A ‘failed instrumental delivery score' (FIDS) may aid practitioners in predicting an increased likelihood of a failed operative vaginal birth and therefore to consider a trial of operative vaginal delivery in the theatre. Senior input should also be sought because a failed operative vaginal birth is associated with increased maternal and fetal morbidity.

journal of pregnancy

Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London