Abstract
BACKGROUND: Among poorer nations, second-stage cesarean sections are more common. Full cervical dilatation with an impacted fetal head necessitates complicated cesarean sections that are linked to a higher risk of problems for both the mother and the fetus. A lower uterine segment that is thinner, less fluid, and a deeply engaged head are typically linked to second-stage cesarean sections. As a result, there may be a greater chance of newborn morbidities including birth hypoxia, NICU admission, and meconium aspiration syndrome, as well as maternal morbidities such an extension of the lower uterine segment incision, uterine atony, and bladder damage. Due to the fetal head's involvement, a second-stage cesarean is technically challenging and is linked to higher rates of morbidity in both the mother and the fetus. Prolonged operating time, significant bleeding, and uterine incision extension into the wide ligament are examples of maternal morbidity.
AIM: The aim of the study is to study the fetomaternal outcome of cesarean sections done in the second stage of labor
MATERIAL AND METHOD: The Department of Obstetrics and Gynecology conducted this prospective observational study. Every lower segment cesarean section carried out in the second stage of labor during the study period was included in the analysis. The patient gave their verbal consent. The start of consistent, painful uterine contractions is known as the onset of labor. The information was taken from the hospital's record section, labor room, and birthing center confinement books. Women with a singleton fetus in a cephalic presentation at term (≥37 weeks) who underwent CS at full dilatation were included in the study. The study excluded patients with concomitant illnesses such as preeclampsia and diabetes. The indications, prenatal outcomes, intraoperative problems, and postoperative complications of women who had second-stage cesarean sections were examined.
RESULTS: There were 6520 deliveries made in total during the study period. Of these, 1589 births were caesarean sectioned. 40 (2.51%) of these cesarean sections were carried out in the second phase. The most frequent reason for LSCS in the second stage of labor—16 instances, or 40% of the total—was non-progress of labor accompanied by fetal distress. This was followed by the deflexed head in 7 cases (17.5%) and deep transverse arrest in 6 cases (15%). In 20 cases (or 50%), the Patwardhan method was the most often used technique for delivering a deeply engaged head. This was followed by the vertex approach in 30% of cases and the push method in 4%. The elongation of uterine angles occurred in 6 cases (15%), atonic PPH in 3 cases (7.5%), bladder injuries in 2 cases (5%), and obstetric hysterectomy in 1 case (2.5%). These were the intra-operative complications.
CONCLUSION: Maternal difficulties and newborn morbidities are linked to cesarean sections performed during the second stage of labor. Maternal and neonatal morbidity as well as newborn death are much higher when cesarean sections are performed during the second stage of labor. To execute a second-stage cesarean section, an experienced obstetrician and sound judgment are needed. Second-stage labor cesarean sections are an unfavorable scenario linked to problems for both the mother and the fetus.
KEYWORDS: Cesarean section, Second stage of labor, Maternal morbidity and Complications