Comparison of the maternal and neonatal outcomes for the cesarean section performed during 1st and 2nd stage of labor
Abstract
Objective: Comparison of maternal and fetal outcomes and complications in pregnant women who have a cesarean delivery in the 2nd stage of active labor with the 1st stage cesarean deliveries. Material & Methods: In this retrospective study, 50 cases who had term, singleton, uncomplicated pregnancy and gave birth by emergency cesarean section in the second stage of labor were compared cases (n=50) who gave birth in the first stage. Demographic characteristics of the cases, indications for cesarean section, intraoperative and postoperative surgical characteristics and complications (uterine incision lengthening, arterial and/or organ injuries, hemoglobin levels, bleeding, need for blood product transfusion, relaparotomy, operation times, postoperative hospital stay) and newborn outcomes were analyzed. A p value of <0.05 was considered statistically significant. Results: The demographic characteristics of the groups (age, number of pregnancies, body mass index, educational status) were similar (p>0.05). The rates of lengthening of the uterine incision, need for lengthening of the uterine incision, uterine artery and bladder injuries, and uterine atony were significantly higher in cesarean sections performed in the second stage (42% vs. 8%, p<0.001). Postoperative hospital stay was similar (p>0.05). Apgar scores, observation and intensive care unit needs were similar in both groups (p>0.05). No trauma or fracture occurred in newborns in either group. Conclusion: Cesarean deliveries in the second stage of active labor cause a significant increase maternal complication, although not in newborns. Performing cesarean deliveries in the second stage by experienced obstetricians is important for the prevention and management of complications.
Keywords
References
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Aktif doğum eyleminin 1. ve 2. evresinde yapılan sezaryenlerde maternal ve neonatal sonuçların karşılaştırılması
Abstract
AMAÇ: Aktif doğum eyleminin 2. evresinde sezaryen ile doğum gerçekleştirilen gebelerde maternal, fetal sonuç ve komplikasyonların 1. evrede yapılan sezaryen doğumlarla karşılaştırılmasıdır.
GEREÇ ve YÖNTEM: Retrospektif çalışmamızda gebelik komplikasyonu gelişmemiş, term, tekil gebeliği olan ve doğum eyleminin 2. evresinde acil sezaryen ile doğumu gerçekleştirilen 50 olgu çalışma grubu, 1. evrede sezaryen ile doğumu gerçekleştirilen aynı sayıda olgu (n=50) ise kontrol grubu olarak çalışmaya alındı. Olguların demografik özellikleri, sezaryen endikasyonları, intraoperatif ve postoperatif cerrahi özellikleri ve komplikasyonları (uterin insizyon uzaması, arter ve organ yaralanmaları, hemoglobin düzeyleri, kan ürünleri transfüzyonu ihtiyacı, relaparatomi, ameliyat süreleri, postoperatif hastanede kalış süresi) ile yenidoğan sonuçları incelendi. p<0.05 istatistiksel anlamlı kabul edildi.
BULGULAR: Grupların yaş, gebelik sayıları, vücut kütle indeksi, eğitim durumu benzerdi (p>0.05). Uterin insizyonun uzaması, uterin insizyonun uzatılmasının gerekmesi, uterin arter ve mesane yaralanmaları ile atoni gelişimi oranları 2. evrede yapılan sezaryenlerde belirgin daha yüksekti (%42’ye karşı %8, p<0.001). Postoperatif hastanede kalış süreleri her iki grupta benzerdi (p>0.05). Apgar skorları, gözlem ve yoğun bakım ihtiyaçları her iki grupta benzerdi (p>0.05) ve hiçbir yenidoğanda travma ya da kırık meydana gelmedi.
SONUÇ: Aktif doğum eyleminin 2. evresinde yapılan sezaryen doğumlar yenidoğanda olmasa da maternal komplikasyonlarda anlamlı artışa neden olur. 2.evrede sezaryen doğumların tecrübeli obstetrisyenler tarafından yapılması komplikasyonların önlenmesi ve yönetilebilmesi konusunda önemlidir.
Keywords
References
- 1- Loudon JAZ, Groom KM, Hinkson L, Harrington D, Paterson-Brown S. Changing trends in operative delivery performed at full dilatation over a 10-year period. J Obstet Gynaecol. 2010; 30:370-5
- 2- Unterscheider J, McMenamin M, Cullinane F. Rising rates of cesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynaecol Reprod Biol. 2011; 157:141-4
- 3- Murphy DJ, Liebling RE, Patel R, Verity L, Swingler R. Cohort study of operative delivery in the second stage of labour and standard of obstetric care. BJOG. 2003; 110:610-5
- 4- Rahim A, Lock G, Cotzias C. Incidence of second-stage (fully dilated) cesarean sections and how best to present it: A multicenter analysis. Int J Gynecol Obstet 2022; 156:119-23
- 5- Sucak A, Celen S, Akbaba E, Soysal S, Moraloglu O, Danısman N. Comparison of nulliparas undergoing cesarean section in first and second stages of labour: a prospective study in a tertiary teaching hospital. Obstet Gynecol Int. 2011; 2011:986506.
- 6- Gifford DS, Morton SC, Fiske M, Keesey J, Keeler E, Kahn KL. Lack of progress in labor as a reason for cesarean. Obstet Gynecol 2000; 95:589-95
- 7- Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014; 123:693-711
- 8- Hendler I, Kirshenbaum M, Barg M, Kees S, Mazaki-Tovi S, Moran O, Kalter A, Schiff E. Choosing between bad, worse and worst: what is the preferred mode of delivery for failure of the second stage of labor? J Matern Fetal Neonatal Med. 2017; 30:1861-4
- 9- Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK. Primary cesarean delivery in the United States. Obstet Gynecol. 2013; 122:33-40
- 10- WHO recommendations: intrapartum care for a positive childbirth experience. Geneva, Switzerland: World Health Organization; 2018. https://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/
- 11- ACOG Committee Opinion No. 766: approaches to limit intervention during labor and birth. Obstet Gynecol 2019; 133: e164-e173.
- 12- Sung JF, Daniels KI, Brodzinsky L, El-Sayed YY, Caughey AB, Lyell DJ. Cesarean delivery outcomes after a prolonged second stage of labor. Am J Obstet Gynecol 2007; 197:306. e1-e5
- 13- Gimovsky AC, Guarente J, Berghella V. Prolonged second stage in nulliparous with epidurals: a systematic review. J Matern Neonatal Med. 2017; 30:461-5
- 14- Gimovsky AC, Berghella V. Randomized controlled trial of prolonged second stage: Extending the time limit vs usual guidelines. Am J Obstet Gynecol. 2016; 214:361.
- 15- Gimovsky AC; Pham A, Ahmadzia HK, Sparks AD, Petersen SM. Risks Associated with Cesarean Delivery during Prolonged Second Stage of Labor. Am J Obstet Gynecol MFM 2021; 3:100276
- 16- Yücel Yetişkin FD, Arslan B, Mihmanlı V, Cambaztepe B, Pektaş G, Pektaş A. Evaluation of maternal and neonatal outcomes in cesarean sections performed in the second stage of labor. Eur Arch Med Res. 2019; 35:54-9
- 17- Hofmeyr GJ, Singata-Madliki M. The second stage of labor. Best Pract Res Clin Obstet Gyanecol 2020; 67:53-64
- 18- Cebekulu L, Buchmann EJ. Complications associated with cesarean section in the second stage of labor. Int J Gynecol Obstet. 2006; 95:110-4
- 19- Altman MR, Lydon-Rochelle MT. Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: A systematic review. Birth. 2006; 33:315-22
- 20- Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S. Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol 2007; 109:917-21
- 21- Govender V, Panday M, Moodley J. Second stage caesarean section at a tertiary hospital in South Africa, J Matern Fetal Neonatal Med 2010; 23:1151–5
- 22- Pergialiotis V, Vlachos DG, Rodolakis A, Haidopoulos D, Thomakos N, Vlachos GD. First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;175: 15-24
Details
| Primary Language | English |
|---|---|
| Subjects | Neonatology |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | October 15, 2023 |
| Acceptance Date | September 20, 2023 |
| Published in Issue | Year 2023 Volume: 11 Issue: 3 |
