DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20173467

First versus second stage caesarean section: a comparison of maternal and neonatal outcomes

Sushma Sinha, Surya Malik, Mala Dixit

Abstract


Background: A retrospective study was done to compare the maternal and neonatal complications of caesarean delivery performed in the second stage compared with the first stage of labor.

Methods: This is a one year retrospective study done in a 100-bedded hospital, govt of NCT OF Delhi, New Delhi from 1st November 2015 to 31st October 2016.  Total number of deliveries in this one year duration were 1785, including both normal and caesarean deliveries. Total number of patients who underwent caesarean delivery in the first stage of labor were 159, and in 2nd stage of labor were 15 during this time period. These were designated into two groups, group 1 and group 2. These two groups were then compared in terms of maternal demographics, labor characteristics, maternal outcomes and neonatal outcomes. Numerical variables were compared between groups by calculating P-value for each variable. P-value <0.05 was considered statistically significant.

Results: Caesarean deliveries performed in the second stage were associated with increased maternal morbidity in terms of blood loss, unintended extensions, blood transfusions, prolonged hospital stay, febrile morbidity. Similarly, Neonatal morbidity was much higher in the patient who underwent LSCS in 2nd stage of labor compared to 1st stage. There was increase in neonatal complications, for e. g. –5 minute Apgar <7, NICU admissions >24 hrs, neonatal septicaemia, (P-value <0.05).

Conclusions: In conclusion, present study suggests that women undergoing caesarean section in the second stage of labor have increased maternal and fetal morbidity. Therefore, selection of birthing method should be made very carefully and meticulously to decrease maternal and neonatal morbidity.


Keywords


Caesarean delivery, Neonatal septicaemia, Fetal pillow

Full Text:

PDF

References


Dumont A, De Bernis L, Bouvier-olle MH, Bréart G, MOMA Study Group. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet. 2001;358(9290):1328-33.

Murray SF, Pradenas FS. Health sector reform and rise of caesarean with in Chile. Lancet. 1997;349(9044):64.

Pai M, Sundaram P, Radhakrishnan KK, Thomas K, Muliyil JP. A high rate of Caesarean sections in an affluent section of Chennai .is it cause for concern? Natl Med J India. 1999;12(4):156-8.

Jolly J, Walker J, Bhadra K. Subsequent obstetric performance related to mode of delivery. Br J Obstet Gynecol. 1999;10.6 (3):277-32.

Varela FR, Vazquez RH, Menacker F, Ahmed Y, Grant AM, Jamieson DJ. Rates of caesarean delivery among Puerto Rican women. Puerto Rico and the U.S main land 1992-2002. MMWR Morb Mortal Wkly Rep. 2006 Jan 27;55(3):68-71.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of caesarean section rates at teaching hospitals in India. Int J Gynaecol Obstet. 2002;79(2):151-8.

Sreevidya S, Sathiyasekaran BW. High caesarean rates Madras (India): a population based cross sectional study. BJOG. 2003;110:106-111.

Allen VM, O’ Connel, Basket TF. Maternal morbidity associated with caesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol. 2003;102:477-82.

Gei AF. Prevention of the first caesarean delivery: the role of operative vaginal delivery. Semin Perinatol. 2012;36:365-73.

Bailey PE. The disappearing art of instrumental delivery ;time to reverse the trend. Int J Gynecol Obstet. 2005;91:89-96.

Gifford DS, Morton SC, Fiske M, Keesey J, Keeler E, Kahn KL. Lack of progress in labor as a reason for cesarean. Obstet Gynecol. 2000;95(4):589-95.

Seal SL, Kamilya G, Mukherji J, Bhattacharyya SK, De A, Hazra A. Outcome in second-versus first-stage cesarean delivery in a teaching institution in eastern India. Am J Perinatol. 2010;27(06):507-12.

Leung TY, Lao TT. Timing of caesarean section according to urgency. Best Prac Res Clin Obstet Gynecol. 2013;27:251-67.

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 Gynecol. 2014;34(7):598-604.

Das S, Sarkar SK. Fetomaternal outcome in second versus First stage caesarean delivery in a tertiary rural medical college. IOSR J Dent Med Sci. 2014;13(12):28-30.

Allen VM, O’ Connel CM, Baskett TF. Mternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labor. BJOG. 2005;112:986-90.

Sucak A, Celen S, Akbaba E, Soysal S, Moraloglu O, Danisman N. Comparison of nulliparas undergoing caesarean section in first and second stage of labor: a prospective study in a tertiary teaching hospital. Obstet Gynecol Int. 2011;2011:986506.

Rabiu KA, Adewunmi AA, Akinola OI, Eti AE, Tayo AO. Comparison of maternal and neonatal outcomes following caesarean section in second versus first stage of labor in a tertiary hospital in Nigeria. Niger Postgrad Med J. 2011;18:165-71.

Radha P, Tagore S, Rahman MF, Tee J. Maternal and perinatal morbidity after caesarean delivery at full cervical dilatation. Singapore Med J. 2012;53:655-8.