The study of fetomaternal outcome in second stage caesarean section
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20241060Keywords:
Second stage caesarean section, Maternal outcome, Perinatal outcomeAbstract
Background: Caesarean section is commonly perceived as a simple alternative to difficult vaginal birth and in the recent years its prevalence during the second stage is increasing. Caesarean section in second stage of labor has additional associated risks for the mother such as obstetric hemorrhage, extended uterine tear, bladder injury and longer hospital stay. It is also associated with increased neonatal morbidity in terms of NICU admissions, fetal acidemia, hypoxemia and prolonged NICU stay. This study was conducted to know the indications of second stage caesarean section and to assess maternal and neonatal outcomes in second stage caesarean section.
Methods: We conducted a prospective observational study conducted at a tertiary perinatal care center from August 2021 to August 2022. All second stage caesarean sections performed during this period were analyzed in terms of indication for caesarean section, intraoperative, postoperative complications and fetal outcomes.
Results: During the study period there were a total of 10433 deliveries. Out of this, 5392 deliveries done by caesarean section, in which 67 were second stage caesarean section. Deep transverse arrest was the most common indication for caesarean section in second stage of labor. Most common intra operative complication was uterine atony, seen in 32.5% cases. 16 (24%) NICU admission were noted with respiratory distress being the most common indication. 15 (23%) had post operative complications like febrile illness.
Conclusions: Second stage caesarean section is associated with significant maternal and neonatal morbidity. A skilled obstetrician and proper training are required to take appropriate decisions for caesarean section at full dilatation of cervix.
Metrics
References
Katz M, Lunenfeld E, Meizner I, Bashan N, Gross J. The effect of the duration of the second stage of labour on the acid-base state of the fetus. Br J Obstet Gynaecol. 1987;94(5):425-30.
Thomas J, Callwood A, Brocklehurst P, Walker J. The National Sentinel Caesarean Section Audit. BJOG. 2000;107(5):579-80.
Vousden N, Cargill Z, Briley A, Tydeman G, Shennan AH. Caesarean section at full dilatation: incidence, impact and current management. Obstet Gynaecol. 2014;16(3):199-205.
Myles TD, Santolaya J. Maternal and neonatal outcomes in patients with a prolonged second stage of labour. Obstetric Gynecol. 2003;102:52-8.
Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Eng J Med. 2004; 351(25):2581-9.
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(2):141-4.
Babre VM. Review of caesarean sections at full dilatation. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2491-3.
Mayberry LJ, Wood SH, Strange LB, Flee L, Heisler DR, Neilsen SK. Managing second-stage labour. Nurs Women Health. 1999;3(6):28-34.
Keepanasseril A, Shaik N, Kubera NS, Adhisivam B, Maurya DK. Comparison of 'push method' with 'Patwardhan's method' on maternal and perinatal outcomes in women undergoing caesarean section in second stage. J Obstet Gynaecol. 2019;39(5):606-11.
Gurung P, Malla S, Lama S, Malla A, Singh A. Caesarean Section During Second Stage of Labor in a Tertiary Centre. J Nepal Health Res Counc. 2017; 15(2):178-81.
Cebekulu L, Buchmann EJ. Complications associated with cesarean section in the second stage of labor. Int J Gynaecol Obstet. 2006;95(2):110-4.
Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY, et al. Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol. 2007;109(4):917-21.
Baloch S, Khaskheli M, Khushk IA, Sheeba A. Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section. J Ayub Med Coll Abbottabad. 2008;20(1):87-90.
Anusha SR, Deepak AV, Jacob KJ. Maternal and neonatal outcome in second stage cesarean section versus first stage: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4640-6.
Kumari A. Reducing morbidity in second stage caesarean section by Patwardhan's (shoulder first) method of delivery. Int J Reprod Contracept Obst Gynecol. 2018;7:2208-11.
Asıcıoglu O, Güngördük K, Yildirim G, Asıcıoglu BB, Güngördük OÇ, Ark C, et al. Second-stage vs first-stage caesarean delivery: comparison of maternal and perinatal outcomes. J Obstet Gynaecol. 2014;34(7):598-604.
Samal R, Pallavee P. Fetomaternal outcome of nulliparous women undergoing caesarean section in first and second stage of labour: A prospective study in a tertiary care centre of Puducherry. Obstet Gynecol. 2009;111(2):534-9.
McDonnell S, Chandraharan E. Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London. J Pregnancy. 2015;2015:627810.
Malik N, Gupta A, Dahiya D, Nanda S, Singhal SR. Caesarean Delivery in the Second Stage: Incidence, Effect, and How to Address Rising Rates. J Gynecol Surg. 2021;37(1):10-5.
Khaniya B. Fetomaternal outcome in second stage caesarean section. Nepal Med J. 2020;3(1):279-81.
Goswami KD, Parmar MM, Kunjadiya AN. Study of fetomaternal outcome in second stage caesarean section. Int J Reprod Contracept Obstet Gynecol. 2018;8(6):2169.
Sharma R, Singh D, Gaur P, Joshi D. Intelligent automated drug administration and therapy: future of healthcare. Drug Deliv Transl Res. 2021;11(5):1878-902.
Seal SL, Dey A, Barman SC, Kamilya G, Mukherji J. Does elevating the fetal head prior to delivery using a fetal pillow reduce maternal and fetal complications in a full dilatation caesarean section? A prospective study with historical controls. J Obstet Gynaecol. 2014;34(3):241-4.
Wyn Jones N, Mitchell EJ, Wakefield N, Knight M, Dorling J, Thornton JG, Walker KF. Impacted fetal head during second stage Caesarean birth: A prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2022;272:77-81.
Allen VM, O'Connell CM, Baskett TF. Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. BJOG. 2005;112(7):986-90.
Pallavee P. Fetomaternal outcome of nulliparous women undergoing caesarean section in first and second stage of labour: A prospective study in a tertiary care centre of Puducherry. J Obstet Gynaecol. 2012;12(1):21-9.
Al-Kadri H, Sabr Y, Al-Saif S, Abulaimoun B, Ba'Aqeel H, Saleh A. Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal-neonatal complications. Acta Obstet Gynecol Scand. 2003; 82(7):642-8.
Baloch S, Khaskheli M, Khushk IA, Sheeba A. Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section. J Ayub Med Coll Abbottabad. 2008;20(1):87-90.
