DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20192129

Study of fetomaternal outcome in second stage caesarean section

Kamal D. Goswami, Manisha M. Parmar, Avnika N. Kunjadiya

Abstract


Background: The incidence of second stage caesarean section is more in developing countries. Caesarean sections done at full cervical dilatation with impacted fetal head are difficult and associated with an increased incidence of maternal and fetal complications.

Methods: This was prospective observational study conducted at a tertiary teaching institute. All second stage caesarean sections performed between September 2017 to August 2018 were analysed in terms of incidence, indications of caesarean-section, intra-operative  and postoperative complications, maternal and fetal outcome.

Results: During the study period there were total 7270 deliveries. Out of this 1884 deliveries were done by caesarean section. Out of them 50 were 2nd stage caesarean sections contributing to 2.65% of total sections. Patwardhan method was used in 50% cases for deliveryof deeply engaged head. Intra-operative complications were higher in terms of atonic pph (8%), extension of uterine incision (16%), in 3 cases bladder injury was noticed. Obstetric hysterectomy was required  in 4% cases. 14% cases had postoperative febrile illness and 8% cases had wound infection. 44% babies required NICU admissions and neonatal death was 18%.

Conclusions: Caesarean section in the 2nd stage of labour is associated with significantly increased maternal morbidity. Neonatal morbidity and mortality also increases. A proper judgement is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.


Keywords


Patwardhan method, Postpartum hemorrhage, Second stage caesarean section

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References


Vousden N, Cargill Z, Briley A, Tydeman G, Shennan AH. Caesarean section at full dilatation: incidence, impact and current management. The Obstetrician Gynaecologist. 2014 Jul 1;16(3):199-205.

Unterscheider J, McMenamin M, Cullinane F. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. European J Obstet Gynecol Repro Biol. 2011 Aug 1;157(2):141-4.

Thomas J, Paranjothy S. The national sentinel caesarean section audit report. National Sentinel Caesarean Section Audit Report. 2001.

McKelvey A, Ashe R, McKenna D, Roberts R. Caesarean section in the second stage of labour: a retrospective review of obstetric setting and morbidity. J Obstet Gynaecol. 2010 Apr 1;30(3):264-7.

Loudon JA, Groom KM, Hinkson L, Harrington D, Paterson-Brown S. Changing trends in operative delivery performed at full dilatation over a 10-year period. J Obstet Gynaecol. 2010 May 1;30(4):370-5.

Govender V, Panday M, Moodley J. Second stage caesarean section at a tertiary hospital in South Africa. J Maternal-Fetal Neon Medi. 2010 Oct 1;23(10):1151-5.

Sung JF, Daniels KI, Brodzinsky L, El-Sayed YY, Caughey AB, Lyell DJ. Cesarean delivery outcomes after a prolonged second stage of labor. American J Obstet Gynecol. 2007 Sep 1;197(3):306-e1.

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 Apr 1;109(4):917-21.

Selo-Ojeme D, Sathiyathasan S, Fayyaz M. Caesarean delivery at full cervical dilatation versus caesarean delivery in the first stage of labour: comparison of maternal and perinatal morbidity. Archives Gynecol Obstet. 2008 Sep 1;278(3):245-9.

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. The Lancet. 2001 Oct 13;358(9289):1203-7.

Davis G, Fleming T, Ford K, Mouawad MR, Ludlow J. Caesarean section at full cervical dilatation. Austr New Zealand J Obstet Gynaecol. 2015 Dec;55(6):565-71.

Baloch S, Khaskheli M. Frequency of Second stage Intervention and its outcome in relations with instrumental vaginal delivery versus cesarean section. J Ayub Med Coll Abbottabad. 2008;20(1):87-90.