Caesarean sections during the second stage labour are increasing in prevalence and accounts for approximately one fourth of all primary caesareans. The reasons for this are likely to be multifactorial. Second stage caesareans are more difficult technically, predisposing the mother to surgical injuries and may put the fetus at risk for morbidity due to hypoxia. Hence the increasing trend of caesarean sections at second stage is of major concern in modern obstetrics. We undertook this study to delineate the indications, maternal and foetal morbidity associated with caesarean section in the second stage of labour.
Methods and Material: 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 in the study was collected till the discharge of both mother and baby by the use of a pretested proforma in all the pregnancies which satisfied inclusion criteria. The collected data 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 the incidence of 2nd stage caesarean sections were more seen in primigravida (74%) and 58% of them were in the age group of between 20-25 years. Arrest of descent due to malposition was the most common indication accounting for 64% and average procedure time was 45-60 minutes.PPH (74%) was being the most common complication, 58% required blood transfusion and there were 8 incidences of uterine tear. There were no incidents of bowel or bladder injury and maternal mortality. Neonatal outcome variables like APGAR<3 at 5 minutes, respiratory distress and neonatal death were observed in 9, 28 and 6 deliveries respectively.
Conclusions: We found that although second stage caesarean section was sometimes appropriate, there are no specific guidelines for performing Caesarean Section at full dilatation successfully and safely. A Caesarean Section in second stage of labor is a technically demanding procedure and has additional associated risks for both the mother and fetus due to the nature of emergency situation.