Maternal outcomes following second stage caesarean section in a tertiary hospital in Malaysia: A 6-year retrospective review

Abstract

Introduction: The trend for second stage caesarean section (SSCS) has been rising, and it carries a high rate of maternal and neonatal morbidity. Aim: To determine the prevalence of caesarean section (CS) performed during the second stage of labour and identify maternal outcomes and associated risk factors in these women. Material and methods: This retrospective study was performed in the Hospital University Sains Malaysia (HUSM). Medical records of 207 women with singleton cephalic pregnancies at term who underwent a SSCS between January 1, 2010 and December 31, 2015 were reviewed, and demographic and outcome data were collected. Results and discussion: During the study period, 8,197 (19.3%) out of 42,546 babies were delivered by CS, including 257 (4.1%) SSCSs. Nearly half (49.3%) the women were nulliparous, 182 (87.9%) experienced spontaneous labour and 123 (59.4%) received oxytocin augmentation. Furthermore, 26 (12.6%) of women had post-partum haemorrhage (≥1000 mL), of whom 22 (10.6%) required blood transfusion. Only 1 (0.5%) woman was admitted to the intensive care unit postoperatively, but 163 (78.7%) had an overall hospital stay length of 3 days. Furthermore, 38 (18.4%) and 33 (15.9%) of women experienced extended uterine tear and uterine atony, respectively. Parity (P < 0.001), attempted instrumentation (P < 0.001) and baby’s weight (P < 0.004) were statistically significantly associated with total blood loss. Parity (P < 0.012) and attempted instrumentation (P < 0.001) were risk factors for extended uterine tear. Conclusions: The overall outcomes from SSCS were better compared with studies performed in other centres. Current practices must be maintained or improved to provide the best patient caree.

The use of bubble charts in analyzing the global second-stage cesarean delivery rates: a systematic review

“…The characteristics and the data of these 25 articles are listed respectively in Tables 2 and 3 and shown with a bubble chart ( Figure 2 ). 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50

Figure 1 The PRISMA flowchart AJOG , American Journal of Obstetrics & Gynecology; PRISMA , Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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“… 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50

Figure 1 The PRISMA flowchart AJOG , American Journal of Obstetrics & Gynecology; PRISMA , Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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“…Moreover, 5 of the articles consisted of a mixture of both nulliparous and multiparous subjects, but none of the articles provided separate information according to parity except Hung et al 24 These 5 articles were grouped under group A ( Table 3 ), and its bubble chart is shown in Figure 2 , A. 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 The average pssCD/T of these 5 articles was 18.20% (reported range, 9.06%–30.26%). Their average ssCD/ssB was 0.83% (range, 0.19%–2.76%), whereas their average ssCD-to-AVB ratio was 0.09 (range, 0.05–0.28; available in 4 of 5 articles).…”

“… 30 , 33 , 34 , 36 As the article by Hung et al 24 in group A also provided separate data for different parity, their nulliparous subgroup was also extracted and tabulated in group B ( Table 3 ), and the bubble chart of group B is shown in Figure 2 , B. 2 , 3 , 23 , 24 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 Their average pssCD/T was 15.10% (reported range, 10.97%–32.59%). Their average ssCD/ssB was 4.50% (range, 0.79%–6.46%), whereas their ssCD-to-AVB ratio was 0.18 (range, 0.05–0.63).…”

“…Group C consists of the other 16 articles that did not exclude multiple pregnancies, preterm births, and noncephalic pregnancies. 2 , 3 , 32 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 All of them had a mixture of nulliparous and multiparous subjects, except the study of Fyfe et al, 41 which focused on nulliparous women only. Their average pssCD/T was 21.67% (range, 12.83%–43.59%), their average ssCD/ssB was 1.65% (range, 0.56%–6.66%), and their average ssCD-to-AVB ratio was 0.27 (range, 0.04–1.82; available in 9 articles) ( Table 3 ; Figure 2 , C).…”