Caesarean section in second stage of labour: a commentary on principles and techniques

Caesarean section done at full cervical dilatation (second stage of labour) has been on the rise globally and comes with its own unique challenges and complications. This commentary highlights the peculiar challenges associated with caesarean section in second stage of labour and gives an overview on various principles to be followed and techniques to employ to reduce fetal and maternal morbidity.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211151 ◽

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.

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A study of caesarean section at full cervical dilatation

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201242 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1672

Author(s):

Bijal D. Rami ◽

Somika Kaul ◽

Asha Sailor ◽

Shahna Jindani

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Tertiary Care ◽

Cervical Dilatation ◽

Age Group ◽

Cervical Dilation ◽

Second Stage ◽

Second Stage Of Labour ◽

History Of ◽

Study Institute

Background: Caesarean sections performed in the second stage of labour are difficult and have many implications on both mother and baby. This study was conducted to analyse fetal and maternal outcome in case of caesarean section at full cervical dilatation.Methods: This prospective study was conducted at one of tertiary care teaching institute for period of 1st August 2019 to 31st January 2020. It includes all women delivered by caesarean section at full cervical dilatation at study institute during study period. Cases were looked for parity, maternal age, gestational age, baby birth weight, indication of cesarean section and associated factors.Results: Out of total 3657 deliveries 1690 were delivered by caesarean section, out of which 65 (3.8%) caesarean sections were conducted at full cervical dilation. The most common indication of caesarean section was deep transverse arrest in 66.15% of cases. The maximum number of cases (69.23%) were seen between the age group of 20 to 25 years. Majority of second stage cesarean section (70.77%) were performed in primi gravida. 80% of caesarean sections at full cervical dilatation were performed after 37 weeks of gestation. 15.38% of patients had anemia, 20% had hypertension, 4.61% had history of previous caesarean section. Baby weight at time of birth was 2.5 to 3.5 kg in 67.70% of cases. 15.38% of patients required blood transfusion.Conclusions: A skilled obstetrician is required to take timely and proper decision in such cases and also to conduct cesarean section at second stage of labour.

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

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i11.1514 ◽

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

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Rising rates of second stage caesarean section and its impact on maternal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182751 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2681

Author(s):

Shanmugapriya Kumaresan ◽

Malarvizhi Loganathan

Keyword(s):

Caesarean Section ◽

Caesarean Section Rate ◽

Adverse Outcomes ◽

Cesarean Sections ◽

Maternal Complications ◽

College Hospital ◽

Second Stage Of Labor ◽

Medical College ◽

Second Stage ◽

Second Stage Of Labour

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. With this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlights includes the rate of caesarean deliveries in the second stage of labour, the indications for delivery and the associated maternal morbidity in this cohort of women. Methods: This was a prospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between July, 2016 and December 31, 2017 at government medical college hospital Dharmapuri. The main outcome measures were second stage caesarean section, indications and its maternal morbidity.Results: 250 women underwent caesarean delivery in the advanced labor. Among the 250 patient’s majority of them were in the age group of 21-30 yrs. about 76% of the patients were primigravidae and only the remaining 24% were multigravida. The commonest indications for doing caesarean section in the second stage of labor was cephalo pelvic disproportion and non-reassuring fetal heart rate patterns. The difficult task was delivery of the deeply engaged head, the increased likelihood of intraoperative and post-operative complications.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and morbidity.

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Vulvovaginal Infralevator Haematoma Mimicking the Second Stage of Labour

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/8062793 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

J. O. Awoleke ◽

O. M. Ipinnimo

Keyword(s):

Blood Loss ◽

Tissue Damage ◽

Maternal Morbidity ◽

Perineal Pain ◽

Rare Occurrence ◽

Risk Of Infection ◽

Final Size ◽

Rare Presentation ◽

Second Stage ◽

Second Stage Of Labour

Even though they are quite uncommon, puerperal genital haematomas can be associated with serious maternal morbidity. Key findings are significant perineal pain and, depending on the location, visible swelling. However, attention can be drawn to its progression by the rare occurrence of persistent painful “bearing down” efforts, even after the successful delivery of the baby. The final size of this haematoma and the rare presentation make it truly uncommon. The primary goals of treatment include the prevention of further blood loss, minimizing tissue damage, relieving pain, and reducing the risk of infection. Management is generally conservative for small collections, but surgery is indispensable when they acutely expand in size or are large with worsening symptoms.

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Prolonged second stage of labour including difficult decision-making on operative vaginal delivery and caesarean section

Best Practice in Labour and Delivery ◽

10.1017/cbo9780511635489.009 ◽

2010 ◽

pp. 84-92

Author(s):

Hajeera Butt ◽

Deirdre J. Murphy

Keyword(s):

Decision Making ◽

Caesarean Section ◽

Vaginal Delivery ◽

Difficult Decision ◽

Second Stage ◽

Second Stage Of Labour ◽

Operative Vaginal Delivery

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Management of prolonged second stage of labor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182855 ◽

2018 ◽

Vol 7 (7) ◽

pp. 2527

Author(s):

Sanjay Singh ◽

Uttara Aiyer Kohli ◽

Shakti Vardhan

Keyword(s):

Caesarean Section ◽

Perinatal Morbidity ◽

Management Options ◽

Second Stage Of Labor ◽

Second Stage ◽

Second Stage Of Labour ◽

Definition Of

Second stage of labour has been often neglected leading to increased maternal and perinatal morbidity. Recognising and managing prolonged second stage is a challenge even to an experienced obstetrician. This article reviews the changes in the definition of prolonged second stage over the years. It discusses the causes, recognition and management options along with the difficulties in delivering a patient with prolonged second stage of labour. Though adding an extra hour to the definition of second stage in patients may reduce the rate of caesarean section but some studies also show a rise in maternal and perinatal morbidity. Obstetricians are familiarized to the different techniques of delivery of the impacted head. Once diagnosis of prolonged second stage is confirmed, causes should be identified and addressed, and treatment should be individualised, and timing and mode of intervention planned.

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