Abstract

Research Article

Second Stage of Labor Cesarean Section Maternal and Fetal Outcomes

Ahazeej Gurashi, Ameer Osman, Hajar Suliman, Ayat Eltigani, Isra Siralkatim, Hamza Orfali and Awadalla Abdelwahid Suliman*

Published: 26 February, 2024 | Volume 7 - Issue 1 | Pages: 025-033

Background: Cesarean section at the second stage of labor occurs when the mother requires delivery with full dilatation of the cervix by cesarean section (CS), which poses a risk to the mother and fetus.
Purpose: To study the maternal and fetal outcomes of second-stage cesarean section. 
Methods: This comparative study was conducted at Alhasahisa Teaching Hospital from August 2021 to January 2022. The study sample comprised 226 women who fulfilled the inclusion criteria, including 113 who delivered by second-stage cesarean section and 113 who delivered by first-stage labor cesarean section as controls. Data were collected using a questionnaire filled out by doctors after informed consent was obtained. 
Results: The common indications in women who delivered via second-stage cesarean section were fetal distress in 62(51.9%), obstructed labor in 26(23%), and failure to progress in 25(22.1%). In women who underwent first-stage cesarean section, the common indications were failure to progress in 85(75.2%), fetal distress in 16(14.2%), and chorioamnionitis in 12(10.6%) (p < 0.05).  
The reported maternal complications in women who underwent second-stage cesarean section were postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in eight (7.1%), extended tears in four (3.5%), umbilical cord prolapse in three (2.7%), and episiotomy in three (2.7%). 
The admission to the neonatal intensive care unit (NICU) and the causes of admission were 
more common among the babies of the women delivered by second-stage cesarean section than the babies of the women delivered by first-stage cesarean section (p value < 0.05). 
Maternal complications in women who underwent second-stage cesarean section included postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in 8(7.1%), uterine extension in 4(3.5%), umbilical cord prolapse in 3(2.7%), and episiotomy in 3(2.7%) (p < 0.05).
Conclusion: Second-stage labor cesarean section showed more complications of postpartum hemorrhage, sepsis, and extended tears, as well as more fetal complications, such as admission to the neonatal intensive care unit, fresh stillbirths, low Apgar scores, and birth asphyxia.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001159 Cite this Article Read Full Article PDF

Keywords:

Second stage; Labor; Cesarean section; Maternal; Fetal; Outcome

References

  1. Goswami KD, Parmar MM, Kunjadiya AN. Study of fetomaternal outcome in second stage cesarean section. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019; 8(6): 2169-2172.
  2. Offringa Y, Paret L, Vayssiere C, Parant O, Loussert L, Guerby P. Second stage cesarean section and the risk of preterm birth in subsequent pregnancies. Int J Gynaecol Obstet. 2022 Dec;159(3):783-789. doi: 10.1002/ijgo.14186. Epub 2022 Apr 6. PMID: 35307823.
  3. Kawakita T, Reddy UM, Grantz KL, Landy HJ, Desale S, Iqbal SN. Maternal outcomes associated with early preterm cesarean delivery. Am J Obstet Gynecol. 2017 Mar;216(3):312.e1-312.e9. doi: 10.1016/j.ajog.2016.11.1006. Epub 2016 Nov 10. PMID: 27840144; PMCID: PMC5334149.
  4. Davis G, Fleming T, Ford K, Mouawad MR, Ludlow J. Caesarean section at full cervical dilatation. Aust N Z J Obstet Gynaecol. 2015 Dec;55(6):565-71. doi: 10.1111/ajo.12374. Epub 2015 Jul 30. PMID: 26223774.
  5. Janani S. Primary Caesarean Section: A Prospective Observational study (Doctoral dissertation, Kilpauk Medical College, Chennai). 2020.
  6. Corry EMA, Ramphul M, Rowan AM, Segurado R, Mahony RM, Keane DP. Exploring full cervical dilatation caesarean sections-A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2018 May;224:188-191. doi: 10.1016/j.ejogrb.2018.03.031. Epub 2018 Mar 20. PMID: 29614445.
  7. Rada MP, Ciortea R, Măluțan AM, Prundeanu I, Doumouchtsis SK, Bucuri CE, Blaga LD, Mihu D. Maternal and neonatal outcomes associated with delivery techniques for impacted fetal head at cesarean section: a systematic review and meta-analysis. J Perinat Med. 2022 Feb 7;50(4):446-456. doi: 10.1515/jpm-2021-0572. PMID: 35119802.
  8. McKinney JR, Allshouse AA, Heyborne KD. Duration of labor and maternal and neonatal morbidity. Am J Obstet Gynecol MFM. 2019 Aug;1(3):100032. doi: 10.1016/j.ajogmf.2019.100032. Epub 2019 Aug 5. PMID: 33345796.
  9. Patil DA, Deshmukh V, Gadappa S, Chandwade Comparative Study of Maternal and Neonatal Outcomes in Second Stage LSCS Vs First Stage LSCS in Tertiary Care Centre. International Journal of Medical and Pharmaceutical Research. 2023;  4: 625-632.
  10. Anuff H, Rahman Z, Dube R, Al-Zuheiri ST. Comparison of Maternal and Neonatal Outcomes in Case of Primary Cesarean Section Done During Late vs. Early Labor. Applied Clinical Research, Clinical Trials and Regulatory Affairs. 2020; 7(3): 244-253.
  11. Flatley CJ. Maternal and perinatal factors associated with adverse perinatal outcomes at term and the development of a predictive model for identification of at-risk pregnancies. 2019.
  12. Dickinson FM, Allott H, Nyongesa P, Eyinda M, Muchemi OM, Karangau SW, Ogoti E, Shaban NA, Godia P, Nyaga L, Ameh CA. "It's complicated…": Exploring second stage caesarean sections and reasons for non-performance of assisted vaginal births in Kenya: A mixed methods study. PLOS Glob Public Health. 2023 Nov 17;3(11):e0001495. doi: 10.1371/journal.pgph.0001495. PMID: 37976293; PMCID: PMC10656000.
  13. Azza Jaafar B, Rihab Jaafar I, Yassir Ahmed Mohammed E, Awad Ali MA, Siddig Omer MH. Maternal and Perinatal Outcomes Among Women Underwent Second-Stage Versus First-Stage Caesarean Delivery at Ibrahim Malik Hospital in Sudan. WJ Gynecol Women’s Health. 1(3): 2018.
  14. Mandar O, Hassan B, Abdelbagi O, Eltayeb R, ALhabardi N, Adam I. Prevalence and Associated Factors for Post-Caesarean Delivery Blood Transfusion in Eastern Sudan: A Cross-Sectional Study. J Blood Med. 2022 May 9;13:219-227. doi: 10.2147/JBM.S355846. PMID: 35585876; PMCID: PMC9109909.
  15. Eltigani A, Ahmed TU, Suliman AA, SalahEldin A, Siralkatim I, Suliman H. Near-miss Women Causes and Prevalence in Alobied Maternity Hospital. Clinical Journal of Obstetrics and Gynecology. 2023; 6(4): 185-192.
  16. Alemu H, Yigzaw ZA, Asrade L, Nega B, Belachew A. Proportion and associated factors of maternal complications of cesarean sections among mothers who deliver at Bahir Dar City Public Specialized Hospitals, Bahir Dar, Ethiopia. BMC Womens Health. 2023 May 6;23(1):237. doi: 10.1186/s12905-023-02388-y. PMID: 37149559; PMCID: PMC10164306.
  17. Vitner D, Bleicher I, Levy E, Sloma R, Kadour-Peero E, Bart Y, Sagi S, Aviram A, Gonen R. Differences in outcomes between cesarean section in the second versus the first stages of labor. J Matern Fetal Neonatal Med. 2019 Aug;32(15):2539-2542. doi: 10.1080/14767058.2018.1440545. Epub 2018 Feb 22. PMID: 29471705.
  18. Sapir A, Friedrich L, Gat R, Erez O. Cesarean section in the second stage of labor is associated with early-term and late preterm birth in subsequent pregnancies. J Matern Fetal Neonatal Med. 2023 Dec;36(1):2175658. doi: 10.1080/14767058.2023.2175658. PMID: 36842965.
  19. Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, O'Sullivan MJ, Sibai BM, Langer O, Gabbe SG; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol. 2007 Apr;109(4):917-21. doi: 10.1097/01.AOG.0000257121.56126.fe. PMID: 17400854.
  20. Rahim A, Lock G, Cotzias C. Incidence of second-stage (fully dilated) cesarean sections and how best to represent it: A multicenter analysis. Int J Gynaecol Obstet. 2022 Jan;156(1):119-123. doi: 10.1002/ijgo.13672. Epub 2021 Apr 4. PMID: 33715159.
  21. Reid HE, Hayes D, Wittkowski A, Vause S, Whitcombe J, Heazell A. The effect of senior obstetric presence on maternal and neonatal outcomes in UK NHS maternity units: a systematic review and meta-analysis. BJOG. 2017 Aug;124(9):1321-1330. doi: 10.1111/1471-0528.14649. Epub 2017 May 5. PMID: 28332762.
  22. Ramphul M, Ooi PV, Burke G, Kennelly MM, Said SA, Montgomery AA, Murphy DJ. Instrumental delivery and ultrasound : a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery. BJOG. 2014 Jul;121(8):1029-38. doi: 10.1111/1471-0528.12810. Epub 2014 Apr 11. PMID: 24720273.
  23. Lawani LO, Anozie OB, Ezeonu PO, Iyoke CA. Comparison of outcomes between operative vaginal deliveries and spontaneous vaginal deliveries in southeast Nigeria. Int J Gynaecol Obstet. 2014 Jun;125(3):206-9. doi: 10.1016/j.ijgo.2013.11.018. Epub 2014 Mar 11. PMID: 24717812.
  24. Vousden N, Cargill Z, Briley A, Tydeman G, Shennan AH. Cesarean section at full dilatation: incidence, impact, and current management. Obstet Gynaecol. 2014; 16(3): 199-205.
  25. Khaniya B. The fetomaternal outcome in second stage cesarean section. Nepalese Medical Journal. 3(1), 279-281.
  26. Eze P, Lawani LO, Chikezie RU, Ukaegbe CI, Iyoke CA. Perinatal outcomes of babies delivered by second-stage cesarean section versus vacuum extraction in a resource-poor setting, Nigeria–a retrospective analysis. BMC pregnancy and childbirth. 2020; 20: 1-7.
  27. Anusha SR. Our experience of maternal and fetal outcomes in 2nd stage cesarean deliveries-tertiary care center study. Blood Transfusion. 2020; 29: 58.
  28. Samal R, Pallavee P. The fetomaternal outcome of nulliparous women undergoing cesarean section in the first and second stage of labor: A prospective study in a tertiary care center of Puducherry. Int J Clin Obstet Gynaecol. 2019; 3(5): 166-9.
  29. Jombo S, Ossai C, Onwusulu D, Ilikannu S, Fagbemi A. Feto-maternal outcomes of caesarean delivery in Federal Medical Centre, Asaba: a two year review. Afr Health Sci. 2022 Mar;22(1):172-179. doi: 10.4314/ahs.v22i1.22. PMID: 36032432; PMCID: PMC9382540.
  30. Gupta N, Gupta T, Singh R. The feto-maternal outcome in second versus first stage cesarean delivery in a tertiary medical care center. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018; 7(12): 5084-5088.
  31. Thirukumar M. Feto-Maternal Outcome in Caesarean Sections Performed in Second Stage of Labour. Jaffna Medical Journal. 2020; 32(1).
  32. Vashi CA, Vijay N, Bhalerao A, Shetty A, Vashi C. Obstetrics Outcomes in Women Undergoing Second-Stage Cesarean Section: A Cross-Sectional Study. 2023; 15(6).
  33. Umbeli T, Ismail S, Kunna A, Elmahgoub A, Nasr A, Abdalwahab R. Maternal and neonatal complications associated with cesarean section in the second stage of labor at Omdurman maternity hospital during 2012-2013. Merit Research Journal of Medicine and Medical Sciences. 2014; 2(10): 225-228.
  34. Sucak A, Celen S, 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. Obstet Gynecol Int. 2011;2011:986506. doi: 10.1155/2011/986506. Epub 2011 Sep 20. PMID: 21941557; PMCID: PMC3176624.
  35. 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;30(3):264-7. doi: 10.3109/01443610903572109. PMID: 20373928.
  36. Babre VM, Bendre KR, Niyogi G. Review of cesarean sections at full dilatation. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017; 6(6): 2491-2494.
  37. Khaniya B. Fetomaternal outcome in second stage cesarean section. NMJ. 2020; 3(1):279-81.
  38. Goswami KD, Parmar MM, Kunjadiya AN. Study of fetomaternal outcome in second stage cesarean section. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019; 8(6): 2169-2172.
  39. Gurung P, Malla S, Lama S, Malla A, Singh A. Caesarean Section During Second Stage of Labor in a Tertiary Centre. J Nepal Health Res Counc. 2017 Sep 8;15(2):178-181. doi: 10.3126/jnhrc.v15i2.18210. PMID: 29016591.

Figures:

Similar Articles

Recently Viewed

  • Social Implementation and Measurement Accuracy Verification of Non-contact Biological Monitors
    Shinji Kondo and Wakita Yoshinori* Shinji Kondo, Wakita Yoshinori*. Social Implementation and Measurement Accuracy Verification of Non-contact Biological Monitors. Clin J Nurs Care Pract. 2024: doi: 10.29328/journal.cjncp.1001052; 8: 011-021
  • Sites and Zones of Maximum Reactivity of the most Stable Structure of the Receptor-binding Domain of Wild-type SARS-CoV-2 Spike Protein: A Quantum Density Functional Theory Study
    Ernesto López-Chávez*, Alberto García-Quiroz, Yesica Antonia Peña-Castañeda, José Antonio Irán Díaz-Góngora, José Alberto Mendoza-Espinosa, J Antonio López-Barrera and Fray de Landa Castillo-Alvarado Ernesto López-Chávez*, Alberto García-Quiroz, Yesica Antonia Peña-Castañeda, José Antonio Irán Díaz-Góngora, José Alberto Mendoza-Espinosa, J Antonio López-Barrera, Fray de Landa Castillo-Alvarado. Sites and Zones of Maximum Reactivity of the most Stable Structure of the Receptor-binding Domain of Wild-type SARS-CoV-2 Spike Protein: A Quantum Density Functional Theory Study. J Clin Intensive Care Med. 2024: doi: 10.29328/journal.jcicm.1001047; 9: 008-016
  • Peripheral perfusion index in critically ill COVID-19 and its association with multiorgan dysfunction
    Cornu Matias German*, Tonelier Matias, Roel Pedro, Sanhueza Laura, Orozco Sergio Martin, Sepulveda Mariana Elizabet, Svampa Silvana Enrica and Arana Osorio Erick and Martinuzzi Andres Luciano Nicolas Cornu Matias German*, Tonelier Matias, Roel Pedro, Sanhueza Laura, Orozco Sergio Martin, Sepulveda Mariana Elizabet, Svampa Silvana Enrica, Arana Osorio Erick and Martinuzzi Andres Luciano Nicolas. Peripheral perfusion index in critically ill COVID-19 and its association with multiorgan dysfunction. J Clin Intensive Care Med. 2023: doi: 10.29328/journal.jcicm.1001043; 8: 004-013
  • Higher venom-specific IgE levels differentiate children with previous local large reactions from children with previous systemic reactions of different severity
    Pastorello Elide Anna*, Borgonovo Linda, Piantanida Marta, Schroeder Jan Walter, Pravettoni Valerio, Pastori Stefano, Bilo’ Maria Beatrice, Toniato Andrea, Aversano Maria Gloria, Farioli Laura, Nichelatti Michele and Preziosi Donatella Pastorello Elide Anna*,Borgonovo Linda,Piantanida Marta,Schroeder Jan Walter,Pravettoni Valerio,Pastori Stefano,Bilo’ Maria Beatrice,Toniato Andrea,Aversano Maria Gloria,Farioli Laura,Nichelatti Michele,Preziosi Donatella. Higher venom-specific IgE levels differentiate children with previous local large reactions from children with previous systemic reactions of different severity. Arch Asthma Allergy Immunol. 2021: doi: 10.29328/journal.aaai.1001025; 5: 017-021
  • Buffer Solutions of known Ionic Strength
    Víctor Cerdà* and Piyawan Phansi Víctor Cerdà*, Piyawan Phansi. Buffer Solutions of known Ionic Strength. Ann Adv Chem. 2023: doi: 10.29328/journal.aac.1001043; 7: 051-056

Read More

Most Viewed

Read More

Help ?