Finding the real effect of cesarean section in the second stage

Abstract

Objective:Finding the real effect of cesarean section in the second stage of labour Study Design: Observational prospective study. Study Settings: Al Karkh Maternity Hospital/Baghdad/Iraq the period between April, 2018 and April, 2019.Patients & Method: A total of 333 term pregnant women in established labour and who had a primary emergency cesarean section either in the first stage or second stage of labor. Demographic characteristics were collected for all participants. A comparison of the outcomes of the two groups was done, it included a maternal outcome, composed of the following: intraoperative surgical complication, blood transfusion, endometritis, or wound complication and a neonatal outcome, which included the following: Apgar score at 5 minutes, weight, intubation in the absence of meconium, neonatal intensive care unit admission, fetal injury or neonatal death.Results: Patients who had a cesarean delivery in the second stage of labour in our study were found to be older, multiparous and had a higher BMI at presentation. Teenagers were more likely to have cesarean section in first stage (12.5% vs. 3% in second stage). Second stage cesarean sections were associated with higher risk of uterine atony (RR 6.28 with 95% CI 4.16-9.4), incisional extensions (RR 19.1 with 95% CI 8.9-40.9), accidental bladder injuries (RR 32.6 with 95% CI 4.2-251), hematomas (RR 4.1 with 95% CI 1.9-8.7), postoperative endometritis (RR 3.08 with 95% CI 1.4-6.3), and required longer time to deliver the baby (5.1 vs. 3.8 minutes p value 0.0001). They were associated with delivery of higher birth weight infants (mean 3.63 kg vs. 3.1kg p value 0.0001). No difference found regarding the 5 minutes APGAR score, fetal injury, nor infant INCU admission between the two groups.Conclusion: Cesarean delivery in the second stage of labour carries high risk of complications in our settings, both intra-operative surgical complications and short-term wound complications were higher than for cesarean delivery in the first stage of labour, and significant enough to warrant seeking for a proper intervention.