A study of second stage caesarean sections at term
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263026Keywords:
Caesarean section, Second stage of labour, Cephalopelvic disproportion, Fetal distress, Impacted fetal head, Fetomaternal outcomeAbstract
Background: Caesarean section (CS) in the second stage of labour is a technically demanding procedure associated with significant maternal and neonatal morbidity. Its rising incidence, driven by declining use of instrumental vaginal delivery and increasing medicolegal concerns, makes it an important area of study. This study aimed to assess the incidence, indications, intraoperative and postoperative complications, and fetomaternal outcomes of second stage CSs at a tertiary care teaching hospital in North India.
Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Christian Medical College and Hospital (CMCH), Ludhiana. Obstetric records of all patients who underwent CS in the second stage of labour between 1st January 2018 and 30th June 2020 were reviewed and analysed.
Results: Of 1372 total CSs performed during the study period, 103 (7.5%) were in the second stage of labour. The majority of women (79.6%) were aged 21-30 years; 66% were primigravidae. Induced labour was present in 56.3% of cases. Cephalopelvic disproportion was the most common indication (33.3%), followed by fetal distress (22.9%). The head push method was used in 71.8% of cases for delivery of the impacted fetal head. Uterine atony was the most common intraoperative complication (21.3%). The majority of women (72%) had no postoperative complications. Fifty-eight percent of neonates had no complications; birth asphyxia (10.7%) and meconium aspiration syndrome (6.8%) were the most common neonatal morbidities.
Conclusions: Second stage CS is associated with significant fetomaternal morbidity. Proactive antenatal assessment, judicious intrapartum management, and structured training in operative vaginal delivery and fetal head disimpaction techniques are essential to reduce its incidence and associated complications.
References
Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671.
Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: a call to action. Health Sci Rep. 2023;6:e1274.
Roy A, Paul P, Chouhan P, Barman B, Bhattacharjee P, Pandey J, et al. Alarming trends of cesarean section- time to rethink: evidence from NFHS-5, India. J Med Internet Res. 2023;25:e41783.
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.
Young C, Bhattacharya S, Woolner A, Ingram A, Smith N, Raja EA, et al. Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women. BMC Pregnancy Childbirth. 2023;23(1):441.
Bhargava S, Hooja N, Kala M. Caesarean delivery in the second stage of labour at a tertiary care hospital. J Obstet Gynaecol India. 2019;69(6):558-60.
Kumaresan S, Rathore S, Sharma N, Singh R. Rising rates of second stage caesarean section and its impact on maternal outcome. Int J Reprod Contracept Obstet Gynecol. 2018;7(7):2681-5.
Landesman R, Graber EA. Abdominovaginal delivery: modification of the cesarean section operation to facilitate delivery of the impacted head. Am J Obstet Gynecol. 1984;148(6):707-10.
Fasubaa OB, Ezechi OC, Orji EO, Ogunniyi SO, Akindele ST, Loto OM, et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomised comparative study of two methods. J Obstet Gynaecol. 2002;22(4):375-8.
Levy R, Chernomoretz T, Appelman Z, Lein D, Or Y, Hagay ZJ. Head pushing versus reverse breech extraction in cases of impacted fetal head during cesarean section. Eur J Obstet Gynecol Reprod Biol. 2005;121(1):24-6.
World Health Organization. WHO Statement on Caesarean Section Rates. Geneva: World Health Organization (WHO/RHR/15.02). 2015.
Davis G, Fleming T, Ford K, Mouawad MR, Ludlow J. Caesarean section at full cervical dilatation. Aust N Z J Obstet Gynaecol. 2015;55(6):565-71.
Kumari M, Patel AD. Operative difficulties in second stage caesarean section: an obstetrician's nightmare. Int J Reprod Contracept Obstet Gynecol. 2024;13(3):630-3.
Cebekulu L, Buchman EJ. Complications associated with caesarean section in the second stage of labour. Int J Gynecol Obstet. 2006;95(2):110-4.
Murphy DJ, Liebling RE, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001;358(9289):1203-7.
Goswami KD, Soni R, Patel K, Shah M. Study of fetomaternal outcome in second stage caesarean section. Int J Reprod Contracept Obstet Gynecol. 2019;8(6):2398-402.
Sapir A, Friedrich L, Gat R, Erez O. Cesarean section in the second stage of labor is associated with early-term and late preterm birth in subsequent pregnancies. J Matern Fetal Neonatal Med. 2023;36(1):2175658.
Babre VM, Pandya JS, Patel LR. Review of caesarean sections at full dilatation. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2491-3.
Chandrashekhar AB, Ramakrishnappa HC, Nagaraj R, Iyengar SL. Maternal and fetal outcome in second stage caesarean section: a retrospective study. Int J Reprod Contracept Obstet Gynecol. 2024;13(4):993-6.
Qadir M, Amir S. Maternal morbidity associated with caesarean section in second stage of labor. J Med Sci. 2017;25(2):242-5.
Gq Peak A, Barwise E, Walker KF. Techniques for managing an impacted fetal head at caesarean section: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2023;281:12-22.
Rada MP, Ciortea R, Măluţan AM, Mocan-Hognogi RF, Bucuri CE, Mihu D. Maternal and neonatal outcomes associated with delivery techniques for impacted fetal head at cesarean section: a systematic review and meta-analysis. J Perinat Med. 2022;50(4):446-56.
Berghella V, Gimovsky AC, Levine LD, Vink J. Cesarean in the second stage: a possible risk factor for subsequent spontaneous preterm birth. Am J Obstet Gynecol. 2017;217(1):1-3.
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