First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis

Pergialiotis, Vasilios; Vlachos, Dimitrios‐Efthymios; Rodolakis, Alexandros; Haidopoulos, Dimitrios; Thomakos, Nikolaos; Vlachos, Georgios

doi:10.1016/j.ejogrb.2013.12.033

Cited by 47 publications

(34 citation statements)

References 29 publications

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“…In this large retrospective cohort study, conducted in a health system with one of the lowest rates of CD among the countries of the OECD [5] we observed that large fetal size and POP presentation increased the odds of UCD being performed in the second stage of labor, while prematurity and induction of labor led more often to UCD being performed in the first stage of labor. The rates of complications with second-stage UCD observed in our cohort did not differ from those reported in other health systems with high CD rates [7,8,11,13]. Furthermore, in this cohort comprising 7,635 singleton UCDs at all weeks of gestation, we found that only a minority of these UCDs were performed in the second stage, comprising 4% of primiparous laboring women and 0.7% of multiparas.…”

Section: Discussionsupporting

confidence: 43%

“…CD performed in the second stage is a more challenging surgical procedure than in the first stage or before labor [8][9][10]. When performed in the second stage of labor, it is known that CD carries higher risks of maternal and fetal complications, including maternal intraoperative trauma and hemorrhage, prolonged operation time, a neonatal 5-min Apgar score < 3 or < 7, neonatal intensive care unit (NICU) admission, and other intraoperative complications [6][7][8][9][11][12][13][14]. CD performed during the second stage can affect future deliveries; higher rates of spontaneous preterm delivery were found to be associated with pregnancies after a previous second-stage CD [15].…”

Section: Introductionmentioning

confidence: 99%

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Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas

et al. 2020

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Background: While endeavors to reduce cesarean delivery (CD) rates are given priority worldwide, it is important to evaluate if these efforts place parturients and neonates at risk. CD performed in the second stage of labor carries higher risks of maternal and fetal complications and is a more challenging surgical procedure than that performed in the first stage or before labor. In a population with a low CD rate, we sought to evaluate the rate of maternal and fetal complications associated with unplanned CD (UCD) performed in the second vs. the first stage of labor, in primiparas and multiparas, as well as the risk factors leading to and the complications associated with UCD in the second stage of labor in this low-CD rate setting. Methods: This was a retrospective, electronic medical record-based study of 7,635 term and preterm singletons born via UCD in the period 2003-2015. Maternal and neonatal background and outcome parameters were compared between groups. Logistic regression modeling was applied to adjust for clinically and statistically significant risk factors. Results: UCD was more likely to be performed in the second stage of labor in mothers delivering larger fetuses (head circumference and body weight ≥90 centile) and those with persistent occiput posterior (POP) presentation. UCD in the second stage was strongly associated with serious maternal complications (excessive hemorrhage and fever) compared to UCD performed in the first stage, in both primiparas and multiparas. Conclusions: UCD performed in the second stage of labor, while less frequent than first-stage UCD, is more likely with larger neonates and POP presentation, and is associated with a higher rate of maternal complications in primiparas and multiparas. Complication rates in our low-CD-rate population did not exceed those reported in the literature from high-CD-rate areas.

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Section: Discussionsupporting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas

et al. 2020

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“…It has recently been demonstrated that, while the majority of obstetricians considered rotation of the fetal head to be an acceptable intervention (97%), less than half (41%) had performed it within the previous year [5]. Second-stage cesarean section is an increasingly common alternative [6], but carries a significant burden of maternal morbidity [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

Management of fetal malposition in the second stage of labor: a propensity score analysis

Aiken¹,

Aiken²,

Alberry³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To determine the factors associated with selection of rotational instrumental versus cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments versus cesarean section. Study Design We conducted a retrospective cohort study over a 5-year period in a tertiary UK obstetrics center. 868 women with vertex-presenting, single, live-born infants at term with persistent malposition in the second stage of labor were included. Propensity-score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean section. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse versus cesarean section, adjusting for propensity scores. Results Increased likelihood of rotational instrumental delivery was associated with lower maternal age (OR= 0.95 p<0.01), lower BMI (OR=0.94 p<0.001), lower birth-weight (OR=0.95 p<0.01), no evidence of fetal compromise at the time of delivery (OR=0.31 p<0.001), delivery during the daytime (OR= 1.45, P<0.05), and delivery by a more experienced obstetrician (OR=7.21 p<0.001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8± 48ml p<0.001). Conclusions Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean section rates.

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“…There is evidence that the incidence of second stage caesarean sections is increasing . These are associated with an increase in maternal morbidity, including haemorrhage, wound extension and visceral trauma . Similarly, there is a higher risk of fetal trauma associated with difficulty in delivering a deeply impacted head.…”

Section: Caesarean Section At Full Dilatationmentioning

confidence: 99%

“…38 These are associated with an increase in maternal morbidity, including haemorrhage, wound extension and visceral trauma. 39 Similarly, there is a higher risk of fetal trauma associated with difficulty in delivering a deeply impacted head. Fetal head lifting devices are under evaluation and have been associated with statistically significant reductions in operating time, incision to delivery time and uterine extensions, although the evidence base is limited.…”

Section: Caesarean Section At Full Dilatationmentioning

confidence: 99%

Complications of caesarean section

Field

Haloob

2016

The Obstetric & Gynaecologis

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Key content The incidence and presentation of complications of caesarean section. The surgical management of intrapartum and postpartum haemorrhage. Risk factors for, and prevention and treatment of postpartum sepsis. Presentation, investigation and repair of bladder injuries when recognised intraoperatively and following delayed presentation. Risk factors for, and recognition and management of suspected ureteric injury intraoperatively and postoperatively. Bowel complications including intraoperative bowel injury and management, postoperative ileus and Ogilvie syndrome. Particular risks and complications associated with caesarean section at full dilatation. Caesarean section in the developing world. Learning objectives To be aware of the most common and serious complications of caesarean section. To be able to describe recognition and initial surgical management of suspected bladder, ureteric and bowel injuries. To be familiar with delayed presentations of visceral injuries and have a systematic approach to investigation of suspected injury. To understand the impact of caesarean section complications in resource‐poor countries. Ethical issues Appropriate, accurate preoperative counselling regarding risks and consent. Awareness of personal competency in managing specific complications.

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First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis

Cited by 47 publications

References 29 publications

Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas

Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas

Management of fetal malposition in the second stage of labor: a propensity score analysis

Complications of caesarean section

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