Retrospective Analysis of Second Stage of Cesarean Section and Pregnancy Outcomes: An Observational Study (original) (raw)
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Caesarean Section During Second Stage of Labor in a Tertiary Centre
Journal of Nepal Health Research Council
Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour. Methods: This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity. Results: During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen. Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.
Fetomaternal Outcome in Cesarean Sections Done in Second Stage of Labor
To study the fetomaternal outcome in cesarean sections done in second stage of labor. Method: It is a prospective observational study of 26 cases of cesarean sections done in second stage of labor in Adichunchanagiri institute of medical sciences from January to September 2014. Result: There were 1533 deliveries including 468 cesarean sections in the study period. The cesarean rate was 30%. Of 468 cases 26 were performed in second stage of labor contributing 1.6% of total deliveries and 5.5% of all cesarean sections. Most common indication for cesarean section in second stage of labor is deep transverse arrest. Second stage cesarean sections are associated with increased risk of atonic PPH requiring surgical management (7.69%), lower segment tears including angle extension and broad ligament hematoma(15.38%) along with other complications like extraction difficulty, post operative fever, wound sepsis, longer duration of hospital stay. Meconium stained amniotic fluid is present in 30.76% cases. Though timely second stage ceserean sections reduce perinatal mortality few complications like neonatal hyperbilirubinemia occur. Conclusion: Cesarean sections done in second stage of labor are associated with increased intra-operative maternal complications and neonatal morbidity. Theme: Healthy mother, healthy baby: Timely intervention to reduce fetomaternal complications.
Finding the real effect of cesarean section in the second stage
International Journal of Advanced Research in Medicine, 2020
Finding the real effect of cesarean section in the second stage of labour Study Design: Observational prospective study. Study Settings: Al Karkh Maternity Hospital/Baghdad/Iraq the period between April, 2018 and April, 2019. Patients & Method: A total of 333 term pregnant women in established labour and who had a primary emergency cesarean section either in the first stage or second stage of labor. Demographic characteristics were collected for all participants. A comparison of the outcomes of the two groups was done, it included a maternal outcome, composed of the following: intraoperative surgical complication, blood transfusion, endometritis, or wound complication and a neonatal outcome, which included the following: Apgar score at 5 minutes, weight, intubation in the absence of meconium, neonatal intensive care unit admission, fetal injury or neonatal death. Results: Patients who had a cesarean delivery in the second stage of labour in our study were found to be older, multiparous and had a higher BMI at presentation. Teenagers were more likely to have cesarean section in first stage (12.5% vs. 3% in second stage). Second stage cesarean sections were associated with higher risk of uterine atony (RR 6.28 with 95% CI 4.16-9.4), incisional extensions (RR 19.1 with 95% CI 8.9-40.9), accidental bladder injuries (RR 32.6 with 95% CI 4.2-251), hematomas (RR 4.1 with 95% CI 1.9-8.7), postoperative endometritis (RR 3.08 with 95% CI 1.4-6.3), and required longer time to deliver the baby (5.1 vs. 3.8 minutes p value 0.0001). They were associated with delivery of higher birth weight infants (mean 3.63 kg vs. 3.1kg p value 0.0001). No difference found regarding the 5 minutes APGAR score, fetal injury, nor infant INCU admission between the two groups. Conclusion: Cesarean delivery in the second stage of labour carries high risk of complications in our settings, both intra-operative surgical complications and short-term wound complications were higher than for cesarean delivery in the first stage of labour, and significant enough to warrant seeking for a proper intervention.
IOSR Journals , 2019
Aim and Objectives: 1. To study the maternal and fetal morbidityandmortality associated with cesarean section done in first and second stages of labour. Material and Methods: It is an observational cross sectional study conducted at Gandhi hospital during the period of 2015-2017 in the department of Obstetrics and Gynecology of about 200 parturient women undergoing primary cesarean section in first and second stages of labour. Booked and unbooked cases, parity,indications for cesarean section, intra operative complications and post operativecomplications for the mother are studied. Weight of the new born, APGAR scores, No.of NICU admissions , their indications and outcome are also studied. Results: primary cesarean sections in second stage of labour were high among primies (75%).For the second stage cesarean sections, CPD (56.25%) was the common indication. Foetal distress wasthe common indication for first stage cesarean sections (38.04%). Among the Intraoperative complications, Bladder injury in the formofhematuriawas found to be frequent complication in second stage cesarean section and is 4.5 times higher than first stage cesarean section. The incidence of uterine atony (6.25% vs 0.54%) and PPH (31.25% vs 2.7%) were high in second stage cesarean section. Post operative complications liketheneed for Bloodtransfusion(11.95% vs 2.5%) and wound infection (6.25% vs 5.43%) were more in second stage cesarean section. The number of NICU admissions were high 25%in first stage cesarean wen compared to second stage which is 5.43%. Out of thetotal NICU admission ,most of the babies(80%0)recovered in first stage cesarean where as it is less(25%) in second stage cesarean section. Conclusion: Maternal and Neonatal morbidity and mortality was high in second stage cesarean section when compared to first stage cesarean section
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021
Background: Second-stage caesarean sections are known to be associated with increased maternal and perinatal complications as compared to late first stage caesarean sections. The objective of the study was to evaluate the maternal and perinatal outcome of caesarean deliveries in the late first stage and second stage of labour.Methods: The prospective observational study of caesarean deliveries done in the late first stage (~8 cm of cervical dilatation) and second stage of labour was conducted at Lady Goshen Hospital, Mangalore and Kasturba Medical College Attavar, Mangalore from August 2018 to June 2020. Comparison of maternal and perinatal outcomes were assessed in late first stage and second stages of caesarean delivery.Results: In the present study intraoperative complications such as extensions of uterine incisions, atonic PPH and bladder base injury and post-operative complications like need for blood transfusion, febrile morbidity and prolonged catheterisation were found more ...
Caesarean section in second stage of labour: a commentary on principles and techniques
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021
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.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: The incidence of caesarean section has increased tremendously over the recent years. The most common indications of caesarean section are fetal distress and previous caesarean section during first stage caesarean section and cephalo-pelvic disproportion and fetal distress during second stage caesarean section. The objective of this study was to compare maternal and fetal outcomes between first and second stage caesarean section. Methods: A retrospective cohort study was carried out in the department of obstetrics and gynaecology at a tertiary hospital over a period of 6 months. Comparison was done between two groups, women who underwent caesarean section during first stage (group I) and during second stage (group II). Data was collected and compared on basis of maternal and fetal outcomes. Results: Among maternal complications, PPH occurred in significantly higher number of women in group II (21%) than in group I (9%). 21% of women in group II required blood transfusion and 7% admitted to ICU. Bladder injury and uterine incision extension was seen in more number of cases in group II (6% and 7% respectively), difference being statistically insignificant. Neonatal complications were significantly higher in group II. Conclusions: Second stage caesarean sections are associated with significant maternal and fetal morbidities, thus necessitating presence of senior obstetrician at time of decision and conductance of procedure.