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

Author(s):  
Sushma Sinha ◽  
Surya Malik ◽  
Mala Dixit

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.

Author(s):  
Reena Sharma ◽  
Poojan Dogra

Background: Worldwide there has been an increase in the rate of caesarean delivery due to multiple factors. Objective of the study was to assess the prevalence and different indications of caesarean section in this institute.Methods: The aim of the study is to analyse the rates and indications of lower segment caesarean section (LSCS) in our institution. We conducted a retrospective study over a period of six months; 1st September 2016 to 1st March 2017 at SLBSGMC Mandi at Nerchowk. Total number of patients who delivered in our hospital during the defined study period was recorded and a statistical analysis of various parameters was done.Results: The total number of women delivered over the study period was 2075, out of which caesarean sections (CS) were 473. The overall CS rate calculated was 22.8%. Previous LSCS was the leading indication to the CS rate.Conclusions: Routine obstetric audits should be done to analyse the various indications of emergency and elective caesarean sections so that protocols and guidelines can be implemented to curtail the increasing trend of caesarean delivery.


Author(s):  
Vijaya Monish Babre ◽  
Kirti Rajesh Bendre ◽  
Geeta Niyogi

Background: To study indications of second stage caesarean section. To study intraoperative and postoperative complications. To review maternal and perinatal outcome.Methods: This retrospective study was conducted at a tertiary teaching Institute. All second stage caesarean sections performed between a period 2008 to 2012 were analysed in terms of duration of 2nd stage of labour, instrumentation attempted prior to caesarean section, indication of caesarean-section, Intraoperative complications, maternal and perinatal outcome.Results: During the study period 2760, caesarean sections were performed out of them 61 were 2nd stage caesarean section. Out of 61 Caeserean 14 were given prior instrumental trial, followed by 2nd stage caesarean section. Intraoperative complications were higher in terms of blood loss, primary PPH, extension of uterine incision, in one case bladder injury was noticed. Patwardhan method was used in 23% cases for delivery deeply engaged head. Atonic PPH was seen in 11.5% of patiants.3.3% of patients had extension of uterine incision. 54% baby’s required NICU care. Increased incidence of post-operative febrile illness and wound infection were noted.Conclusions: Caeseraen section in the 2nd stage of labour is associated with significantly increased maternal morbidity. Neonatal morbidity and mortality also increases. A proper judgement is required by a skilled obstetrician to take a decision for instrumental delivery or ceaseraen section at full cervical dilatation.


Author(s):  
M. P. A. Sailakshmi ◽  
Vidhyadhare G. S.

Background: Caesarean section at second stage are increasing and are associated with significant maternal morbidity. The overall caesarean section rates are also increasing from last two decades.Methods: A retrospective study conducted in Department of Obstetrics and Gynaecology, Raja Rajeswari Medical College and Hospital, Bangalore from January 2018 to July 2019. Second stage LSCS were analysed in terms of indications, intraoperative and post-operative complications, neonatal morbidity.Results: In our hospital during study period there were 2639 deliveries and total number of LSCS 1146 (43.42%) and caesarean section rate was 35-45% and second stage LSCS 60 (5.23%).Conclusions: Second stage LSCS associated with more number of maternal and neonatal morbidity. Adequate clinical exposure and appropriate training are essential for safe performance in second stage LSCS. 


2016 ◽  
Vol 2 (1) ◽  
pp. 153
Author(s):  
Tomescu Cezar Laurentiu ◽  
Rodica Sîrbu ◽  
Emin Cadar ◽  
Brezeanu Dragos ◽  
Aneta Tomescu

The incidence of breech presentation is approximately 3,97%. Breech presentation is considered as being “borderline eutocic” and it requires carefully monitoring both the foetus and the mother. The aim of the current paper is to evaluate the preffered method of delivery in case of breech presentation. The paper presents a retrospective study performed in the Obstetrics and Gynaecology Departments of the County Emergency Clinical Hospital “Sf. Apostol Andrei” in Constanta, during a period of 5 years (2010-2014). The methods of birth were analyzed for a lot of 1104 patients with breech presentation with ages ranging between 16 and 44 years old. The total number of patients who gave birth through vaginal delivery was of 139 patients, amounting to 12.59% of the total population sample. The number of patients that gave birth through C-section was 965, which amounts to 87.4% of the total population sample. Birth through C-section is preferred by both obstetricians and patients alike, due to the fact that vaginal delivery is associated with a higher foetal risk in breech presentation.


Author(s):  
G. Kuppulakshmi ◽  
S. Saranya

Background: The term caesarean delivery used to describe the delivery of a fetus through a surgical incision of the intact anterior uterine wall. The objective of this study was to analyse the maternal and perinatal morbidity between successful VBAC and failed vaginal delivery in cases selected for trial of labour.Methods: Prospective study conducted in Government RSRM Lying In Hospital, Government Stanley Medical College, Chennai over a period of one year from January 2017 to December 2017.Results: Trial of labour in previous caesarean section was more successful when the interval between previous caesarean and present pregnancy was between two to four years 86.40%. Conclusions: Most patients with a prior caesarean birth are candidates for VBAC. In properly selected women, a trial of labour after one previous low transverse caesarean section constitutes the best and safest form of obstetric management.


Author(s):  
Nurul Nafizah Mohd Rashid ◽  
Nik Mohamed Zaki Nik Mahmood ◽  
Mohd Pazudin Ismail ◽  
Adibah Ibrahim ◽  
W Fadhlina W Adnan ◽  
...  

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.


Author(s):  
Pravinkumar A. Jadav ◽  
Palak M. Dabhi ◽  
Dhruti A. Rathod

Background: Caesarean section (CS) performed in the second stage of labour has many implications for maternal and neonatal morbidity as well as for subsequent pregnancies. The objectives of this study were to determine the rates of CS at full dilatation, their indications, associated maternal and neonatal complications.Methods: This retrospective study assessed all the women with a singleton fetus in cephalic presentation at term (≥37 weeks) who underwent CS in the second stage of labor between 1 August 2019 and 31 March 2020 at a tertiary care hospital. Maternal demographics, labour and delivery details as well as neonatal outcomes were collected.Results: During the study period, 2124 (36%) babies were born by CS. Of these, 49 (2.3%) were performed in the second stage of labour at ≥37 weeks of gestation. The most common indication of CS was non-descent of head in 38 (77.55%) of cases. The majority of women 38 (77.55%) delivered by CS in the second stage of labor were primiparous. The 27 (55.10%) women were in the age group of 20-25 years. Most common intraoperative complication was blood-stained urine in 20 (40.81%) women. Overall transfusion rate was 18.36%. Maximum number of babies born 44 (89.79%) were having birth weight between 2.5-3.5 kg. Out of 65 babies born, 17 (34.69%) were admitted to neonatal intensive care unit.Conclusions: Formulation of an institutional protocol and training and supervision of trainees to improve the skill of operative vaginal delivery and second stage cesarean is needed.


Author(s):  
Eka R Gunardi ◽  
Duta A Tritama ◽  
Luky Satria ◽  
Herbert Situmorang

Objective: To investigate about the rate of pregnancy in womenwho had undergone laparoscopic cystectomy.Methods: This was a retrospective study. Data were taken from themedical records of patients with infertility in Fatmawati Hospital,Jakarta, Indonesia. Data then analyze to know is there anyassociation between age, infertility duration, bilaterality of the cyst,tubal patensy, r-AFS stage with pregnancy rate.Results: A total of 64 subjects were recruited in this study. Therewere 23 subjects (35.9%) that got pregnant within one year afterundergoing laparoscopic procedure. Those who were 35 years oldor less had a greater chance to get pregnant (p = 0.01, OR = 6.75),duration of infertility  3 years had a greater chance to getpregnant with OR = 3.2 and p value = 0.032, r-AFS stage II and IIIhad a greater chance to get pregnant to with (p = 0.04, OR = 3.25and 4.25).Conclusion: The pregnancy rate after laparoscopic procedure is35.9% in this study. There are correlation between age, durationof infertility, and r-AFS staging with pregnancy rate.[Indones J Obstet Gynecol 2018; 6-1: 34-38]Keywords: endometriosis, infertility, laparoscopy, pregnancy


2020 ◽  
Vol 28 (9) ◽  
pp. 660-664
Author(s):  
Christa H Brethouwer ◽  
Sicco A Scherjon ◽  
Ayten Elvan-Taşpinar

Background The gentle caesarean section (GCS) is an alternative to the conventional caesarean section. It aims to optimise the wellbeing of mother and child by mimicking certain aspects of a vaginal delivery when a caesarean section is indicated. Aim To compare the maternal and neonatal outcomes of a GCS in cephalic and breech presentation. Methods In this retrospective study, the outcomes of 180 women who underwent a GCS were analysed, where 120 fetuses were in cephalic and 60 were in breech position. Comparisons were made using Chi-square, Mann-Whitney U and t-tests. Maternal and neonatal outcomes were analysed. Results Apgar 1 was significantly lower for breech position (P=0.019). The Apgar 5 and 10 showed no difference. Neonatal temperature was slightly lower in breech position (36.8°C ± 0.36 versus 36.9°C ± 0.39, P=0.046). Birthweight was significantly lower for breech position (P=0.009). Blood loss was significantly higher in cephalic position (441 ± 230 versus 353 ± 151, P=0.002). Conclusions When performing a GCS, there is no clinically significant difference in maternal or neonatal outcome between a cephalic and a breech presentation. It seems safe to perform a GCS for breech presentation.


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