scholarly journals Study of fetomaternal outcome in second stage caesarean section

2019 ◽  
Vol 8 (6) ◽  
pp. 2169 ◽  
Author(s):  
Kamal D. Goswami ◽  
Manisha M. Parmar ◽  
Avnika N. Kunjadiya
Keyword(s):  
Caesarean Section ◽  
Prospective Observational Study ◽  
Febrile Illness ◽  
Neonatal Morbidity ◽  
Cervical Dilatation ◽  
Bladder Injury ◽  
Fetal Head ◽  
Second Stage ◽  
Uterine Incision ◽  
Tertiary Teaching

Background: The incidence of second stage caesarean section is more in developing countries. Caesarean sections done at full cervical dilatation with impacted fetal head are difficult and associated with an increased incidence of maternal and fetal complications.Methods: This was prospective observational study conducted at a tertiary teaching institute. All second stage caesarean sections performed between September 2017 to August 2018 were analysed in terms of incidence, indications of caesarean-section, intra-operative  and postoperative complications, maternal and fetal outcome.Results: During the study period there were total 7270 deliveries. Out of this 1884 deliveries were done by caesarean section. Out of them 50 were 2nd stage caesarean sections contributing to 2.65% of total sections. Patwardhan method was used in 50% cases for deliveryof deeply engaged head. Intra-operative complications were higher in terms of atonic pph (8%), extension of uterine incision (16%), in 3 cases bladder injury was noticed. Obstetric hysterectomy was required  in 4% cases. 14% cases had postoperative febrile illness and 8% cases had wound infection. 44% babies required NICU admissions and neonatal death was 18%.Conclusions: Caesarean 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 caesarean section at full cervical dilatation.

scholarly journals Review of caesarean sections at full dilatation

2017 ◽  
Vol 6 (6) ◽  
pp. 2491 ◽  
Author(s):  
Vijaya Monish Babre ◽  
Kirti Rajesh Bendre ◽  
Geeta Niyogi
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Maternal Morbidity ◽  
Intraoperative Complications ◽  
Febrile Illness ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Second Stage ◽  
Uterine Incision ◽  
Tertiary Teaching

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.

scholarly journals Maternal and foetal outcome in second stage caesarean section: a prospective study

2021 ◽  
Vol 10 (4) ◽  
pp. 1644
Author(s):  
Shuchi Sharma ◽  
Poojan Dogra ◽  
Reena Sharma ◽  
Suraj Bhardwaj
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Cervical Dilatation ◽  
Bladder Injury ◽  
Fetal Head ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Adjacent Structures ◽  
A Prospective Study

Background: Caesarean section is the most commonly performed abdominal operation in women all over the world. Caesarean sections during the second stage labour accounts for approximately one fourth of all primary caesareans.  Caesarean section at full cervical dilatation is technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased haemorrhage and infection. Aims and objectives were to determine the indications, maternal and foetal morbidity associated with caesarean section in the second stage of labour.Methods: This prospective study included consecutive 50 cases of caesarean section deliveries conducted in second stage of labor for singleton live pregnancies at term. The data collected in the study was analyzed in terms of maternal demographics, indications of caesarean section, intra-operative and postoperative complications and neonatal outcomes.Results: In our series of 50 deliveries, arrest of descent of fetal head due to malposition was the most common indication of caesarean section accounting for 74% and average procedure time was 45-70 minutes. PPH (62%) was the most common complication. Bladder injury was found in 14% cases. Neonatal outcome variables like APGAR<3 at 5 minutes, respiratory distress and neonatal death were observed in 7, 26 and 2 deliveries respectively.Conclusions: Women undergoing cesarean section in second stage of labour are associated with increased maternal and fetal morbidity. They require special care and hence operation should ideally be performed and supervised by an experienced obstetrician. A proper judgement is required to take a decision for caesarean section at full cervical dilatation.

scholarly journals A prospective observational study of fetomaternal outcome in second stage caesarean section

2019 ◽  
Vol 8 (12) ◽  
pp. 4798
Author(s):  
Isha . ◽  
Prabha Lal ◽  
Vikram Dutta ◽  
Aayushi Kaushal
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Caesarean Section Rate ◽  
Birth Asphyxia ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Intraoperative Complication ◽  
Second Stage ◽  
Second Stage Of Labour

Background: Incidence of caesarean section is rapidly rising over last two decades and one fourth is contributed by caesarean section in second stage. The objective of this study was to study of fetomaternal outcome in second stage caesarean section.Methods: Prospective observational study was done in 80 women undergoing second stage caesarean section from December 2015 to March 2017 at Lady Hardinge Medical Collage Delhi. These women observed from labour to caesarean section in second stage of labour till post-operative period for any complication. Intraoperative and postoperative complications were observed in these women.Results: Caesarean section rate was 22% in which 3.9% were done in second stage of labour. Most common gestational age being 39-40 weeks (47%). Most common indication being deep transverse arrest (41.25%). Intraoperative complication as bladder injury (5%), extension of uterine incision (23%), PPH (33%) and need for blood transfusion (31%) and post-operative complication as wound sepsis in 58% and 20% requiring resuturing, post-operative fever, prolong hospital stay, prolonged catheterization etc. neonatal complications as severe birth asphyxia (2.5%), respiratory distress (55%), need for mechanical ventilation.Conclusions: Thus, caesarean section done in second stage of labour is associated with increased maternal and neonatal morbidity.

scholarly journals Fetomaternal outcome in caesarean section at full dilatation

2019 ◽  
Vol 8 (8) ◽  
pp. 3098
Author(s):  
Kavita Gupta ◽  
Apurva Garg
Keyword(s):  
Intraoperative Complications ◽  
Birth Asphyxia ◽  
Febrile Illness ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Cross Sectional Study ◽  
Bladder Injury ◽  
Cesarean Sections ◽  
Cross Sectional ◽  
Uterine Incision

Background: To study indications, intraoperative and postoperative complications and fetomaternal outcome in cesarean sections done at full dilatation.Methods: This is a prospective cross-sectional study which was conducted in the department of obstetrics and gynecology, RNT medical college, Udaipur from November 2018 to April 2019. 100 cases of caesarean sections at full dilatation which were performed during this period were analyzed for indications and maternal and fetal morbidity.Results: Among these 100 cesarean sections, majority of cases were in the age group of 21-30 years (46%), booked and  Primigravida(81%).Most common indications were cephalo-pelvic disproportion (27%) and fetal distress (21%). Most commonly baby was delivered either by vertex (44%) or by Patwardhan (31%). Intraoperative complications were higher in terms of hematuria in 41%, Atonic PPH in 35%, uterine incision extension in 28% of cases. In one case bladder injury was noticed. Increased incidence of post-operative febrile illness and wound infection were noted. 44% baby’s required nursery admission, most commonly due to birth asphyxia (16%) and RDS (11%).Conclusions: Cesarean section in the 2nd stage of labor is associated with significantly increased maternal morbidity, Neonatal morbidity and mortality. So proper monitoring during labor and involvement of skilled obstetrician in decision making and delivery is crucial to minimize fetomaternal complications.

scholarly journals A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anastasia Martin ◽  
Diane Nzelu ◽  
Annette Briley ◽  
Graham Tydeman ◽  
Andrew Shennan
Keyword(s):  
Caesarean Section ◽  
Neonatal Morbidity ◽  
Previous Experience ◽  
Fetal Head ◽  
Digital Technique ◽  
Second Stage ◽  
Head Elevation ◽  
Digital Elevation ◽  
Single Operator ◽  
Established Technique

Abstract Background The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant. Methods We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded Results The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44). With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001). Conclusion On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

scholarly journals FETO-MATERNAL OUTCOME OF CAESAREAN SECTION DURING SECOND STAGE OF LABOR IN A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Ruby Kumari
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Cervical Dilatation ◽  
Care Hospital ◽  
Maternal Complications ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
The Mean

Aim: To highlights the maternal and neonatal outcome of caesarean section in second stage of labour. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology at Government Medical College and Hospital Bettiah, Bihar, India from December 2017 to December  2018. total of 24600 women delivered by caesarean section, 16800 emergency and 7800 elective cases. Of these 400 were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation. All caesarean sections performed at full cervical dilatation over the time period of 1 year at a government hospital were included. Results: Among the 400 patient’s majority of them were in the age group of 20-30 years (72.5%). about 75.5% of the patients were primigravidae and only the remaining 24.5% were multigravida. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH is 48 out of 400 cases (12%). Post-operative wound infection was seen in 23(5.75%) and Post-operative fever was seen in 70(17.5%) out of 400 cases. There were no cases of maternal deaths reported. The mean operative time was 52.9 min .The mean length of hospital stays was 6.6 days. Mean weight of the babies of the second stage caesarean section was 3.2 kg. Conclusions: Caesarean sections done in second stage of labour are associated with several intra-operative maternal complications and neonatal morbidity. Keywords: Caesarean complications; emergency caesarean section; maternal morbidity; neonatal morbidity

Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Shuchi M. Jain ◽  
Ketki. Thool ◽  
Manish A. Jain ◽  
Poonam V. Shivkumar
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Central India ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Care Hospital ◽  
Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

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

2021 ◽  
Author(s):  
Nurul Nafizah Mohd Rashid ◽  
Nik Mohamed Zaki Nik Mahmood ◽  
Mohd Pazudin Ismail ◽  
Adibah Ibrahim ◽  
W Fadhlina W Adnan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Post Partum ◽  
Neonatal Morbidity ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
High Rate ◽  
Maternal Outcomes ◽  
Total Blood ◽  
Second Stage

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.

scholarly journals The maternal and fetal outcome of repeat previous one caesarean section

2021 ◽  
Author(s):  
Uma Jain ◽  
Deepali Jain ◽  
Shaily Sengar ◽  
Preeti Gupta
Keyword(s):  
Caesarean Section ◽  
Placenta Previa ◽  
Birth Asphyxia ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Bladder Injury ◽  
History Of ◽  
Caesarean Hysterectomy ◽  
Placenta Accrete

Background: The rates of adverse maternal and neonatal outcomes have increased significantly in the last decade. Patients with repeated caesarean deliveries also have a greater risk of placenta previa, placenta accrete, uterine rupture, bowel and bladder injury, and unplanned hysterectomy.Methods: This retrospective study was performed between 01 April 2017 to 31 March 2021, at a private hospital to know about the surgical difficulties and maternal and neonatal complications encountered in cases of repeated LSCS. The outcome of 1028 women admitted with a history of previous LSCS was studied.Results: The 613 patients were given a trial of labour. 40.07% of patients delivered normally. The most common indication for repeat LSCS was CPD in 20.94% and fetal distress 20.12%. The most common complication observed was adhesion in 37.65%. Scar dehiscence in 8.92 %, scar rupture in 0.64%, uterine atony in 4.8%, placenta previa in 3.57%, placenta accrete in 0.64%, injury to the bladder was seen in 0.97%, caesarean hysterectomy was done in only 2 cases and gaped wound was found in 1.13% of cases. 19.15% of neonates were admitted to NICU. Apgar score <7 at 5 minutes in 14.77%. premature neonates were 8.44% RDS was found in 7.62%, birth asphyxia was found in 2.92% cases and neonatal sepsis was found in 1.13%.Conclusions: The dramatic increase in caesarean section rates over the past three decades has been associated with a corresponding increase in maternal morbidity but there a continuous decrease in neonatal morbidity and mortality rates because of advances in neonatal medicine.

Operative Deliveries at Full Cervical Dilatation; 'Choosing Between Lesser of Two Evils': A Comparative Study of Morbidities of Vacuum Delivery and Caesarean Section

2020 ◽  
Vol 5 (2) ◽  
pp. 1065-1070
Author(s):  
Shreyashi Aryal ◽  
Deepak Shrestha ◽  
Sweta Mahato
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Comparative Study ◽  
Cervical Dilatation ◽  
Maternal Complications ◽  
Fetal Head ◽  
Chi Square ◽  
Cross Sectional ◽  
Vacuum Delivery ◽  
Chi Square Test

Introduction: Operative delivery at full cervical dilatation can be either a caesarean section or instrumental deliveries. Instrumental deliveries are well debated options for reducing caesarean section rates but they have their own set of maternal and fetal morbidities. CS at full dilatation of cervix is also demanding due to impacted fetal head. Choice between the two depends on the treating obstetrician.  Objective: To assess perinatal morbidities between vacuum delivery and caesarean section at full cervical dilatation.  Methodology: This is an observational cross-sectional comparative study done for the duration of one year from January to December 2019. Women undergoing vacuum delivery or caesarean section in full cervical dilatation were compared for maternal and neonatal morbidities. Risk factors associated with these morbidities were also assessed. The morbidities in each group were compared using Pearson's chi square test. Likelihood of morbidities in relation to risk factors was calculated using univariate logistic regression.  Results: Prevalence of maternal complications in vacuum delivery was 33.3% (28) and in caesarean was 42.9% (15). Neonatal complications in vacuum delivery was 50% (42) and in caesarean was 48.6% (17). Being a referred case (OR=1.14) and a primigravida (OR=1.45) were risk factors for perinatal morbidities in vacuum delivery. Referred cases (OR=1.52), primigravidas (OR=5.90), head station lower than zero (OR=1.26) and birth weight of more than 3500 gms (OR=2.60) were associated with more number of morbidities in caesarean at full cervical dilatation. Conclusion Operative deliveries at full cervical dilatation, either vacuum or CS carry risk of maternal and neonatal morbidities. Obstetrician should make a decision keeping in mind certain risk factors like referred cases, parity, head station, number of pulls, method of delivery of head and fetal weight so that severe morbidities can be prevented.

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