Maternal and neonatal outcome in second stage cesarean section versus first stage: a comparative study
Keywords:Cervical dilatation, Maternal morbidity Second stage cesarean section
Background: Cesarean Section is the most commonly performed abdominal operation in women all over the world. Variable rates of cesarean section are reported between and within countries. Cesarean section at full cervical dilatation with an impacted fetal head can be technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased hemorrhage and infection.
Methods: This is a comparative cross-sectional study comparing maternal and neonatal outcome between first stage and second stage cesarean section performed at Govt Medical College Thrissur.
Results: In present study out of 90 cesarean sections 30 were performed in second stage and 60 in first stage.74 % were primigravida in second stage cs group. Arrest due to malposition was major indication for second stage (76% of cases). The most important complication among second stage cs group was PPH (76.7%) and majority of them needed blood transfusion. These complications were less in first stage cs group. Other Complications like increased duration of surgery (mean=53.3 min), post op fever (36% post op Wound infection (13.3%) was seen in second stage group. Fetal complications like low APGAR scores were seen in 16.7% of cases compared to first stage group and most of them needed resuscitation.
Conclusions: Women undergoing cesarean section in second stage of labour had increased maternal and fetal morbidity. They required special care and hence Operation should ideally perform and supervised by an experienced obstetrician. Timely decision for cesarean section should be made especially when risk factors for failure to progress are present.
Notzon FC, Cnattingius S, Bergsjø P, Cole S, Taffel S, Irgens L, Daltveit AK. Cesarean section Delivery in the 1980's: International comparison by indication. Ame J Obstet Gynecol. 1994;170(2):495-504.
Menticoglou SM, Manning F, Harman C, Morrison I. Perinatal outcome in relation to second stage duration. Am J Obstet Gynecol. 1995;173(3):906-12.
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.
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
Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367(9525):1819-29.
Levy R, Chernomoretz T, Appelman Z, Levin 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.
Sucak A, Çelen Ş, Akbaba E, Soysal S, Moraloglu O, Danışman N. Comparison of nulliparas Undergoing cesarean section in first and second stages of labour: a prospective study in a tertiary Teaching hospital. Obstetrics and gynecology international. 2011; 2011.
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. New Engl J Med. 2004;351(25):2581-9.
Fasubaa OB, Ezechi OC, Orji EO, et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomized comparative study of two methods. J Obstet Gynaecol. 2002;22(4):375-8.
Allen VM, Baskett TF, O‘Connell CM, McKeen D, Allen AC. Maternal and perinatal Outcomes with increasing duration of the second stage of labor. J Obstet Gynaecol. 2009;113(6):1248-58.
Pergialiotis V, Vlachos DG, Rodolakis A, Haidopoulos D, Thomakos N, Vlachos GD. First Versus second stage C/S maternal and neonatal morbidity: a systematic review and metaanalysis. European Journal of Obstet Gynecol Reproduct Biol. 2014;175:15-24.
Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ. Comparison of maternal and infant outcomes From primary cesarean delivery during the second compared with first stage of labor. J Obstet Gynaecol. 2007;109(4):917-21.