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

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.

Association between the stage of labour during caesarean delivery with adverse maternal and neonatal outcomes among referred mothers to tertiary centres in resource-limited settings

“…In agreement with our findings, previous studies 13 22 showed a significant association between the second stage of CD and neonatal morbidity, including an increased incidence of fifth min Apgar score <7 and higher NICU admission rates, but failed to show an association with neonatal death. In disagreement, our findings show that the CD performed at the second stage of labour is not only associated with neonatal morbidity but also with neonatal mortality, in line with other studies.…”

“…The increased amount of blood loss because of uterine atony and unintentional uterine extensions is frequent in the second stage CD, as revealed in the present and previous studies. 13 14 Other studies also showed that unintended uterine extension was associated with longer operation time, more blood loss, postpartum anaemia, and an increased need for blood transfusion. 15 16 …”

“…Concerning neonatal outcomes, one study reported serious neonatal complications are common in the CD performed at the first stage of labour. 10 Nevertheless, other studies found higher poor outcomes in second-stage CD 13 14 21 22 and no association between these measurements. 15 17 23–25 Neonatal adverse outcomes include a low fifth min Apgar score, increased need for neonatal intensive care unit (NICU) admission and neonatal death.…”

Fetomaternal outcome of nulliparous women undergoing caesarean section in first and second stage of labour: A prospective study in a tertiary care centre of Puducherry

“…Total number of patients who underwent caesarean delivery in first stage of labour are 400 and in second stage are 130 during the study period. These were categorized as Group-1: CD in first stage of Labour (n=400) Group-2: CD in second stage of Labour (n=130) These two groups were then compared in terms of maternal demographics, labour characteristics, maternal outcomes and neonatal outcomes Numerical variables were compared between groups by calculating p value for each variables and value <0.05 was taken as statistically significant [9,10,11] . Women delivered by Caesarean Section at full dilation have a higher risk of postpartum hemorrhage, operative morbidity with visceral injury, sepsis and prolonged hospital stay.…”