Maternal and fetal outcome in primary second stage cesarean section: A prospective observational study at tertiary centre in South India

Abstract

There has been increase in the incidence of CS performed and decrease in operative vaginal delivery at full dilatation of cervix. Though the reason is multi factorial, it is technically more challenging and has morbidities specific to, than done in early labor.A prospective observational study was carried out in the department of Obstetrics and Gynecology, BMCRC, Ballari for one year. A total of 100 singleton primary caesarean section cases that underwent CS in second stage of labor meeting the inclusion and exclusion criteria were recruited in the study. Demographic data, investigations indication were noted. Both intra operative and postoperative details of mother and neonates were documented. The accumulated data was evaluated and statistically analyzed.Maximum numbers of cases were between 21-25yrs. 80 cases were primigravidae and were of gestational age 39 weeks to 40 weeks. 62 cases were operated for arrest of decent and 53 babies were extracted by Patwardhan method. Angle extension was seen in 6 cases. Prolonged catheterization was done in 14 cases. 40 babies required NICU admission.14 neonates died in the early neonatal period, 50% were due to birth asphyxia.Quick access to senior obstetrician at all CS deliveries at full dilatation has resulted in more use of Patwardhan method of extraction and less complications. However being tertiary care centre to receive delayed referral, untreated anemia has resulted in more blood transfusions, prolonged catheterization and increased neonatal morbidity and mortality. Further research is needed to frame uniform guidelines, specific technique for delivery of fetus at full dilatation, training module for obstetricians to perform CS in second stage of labor.