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Applied Clinical Research, Clinical Trials and Regulatory Affairs (Discontinued)

Editor-in-Chief

ISSN (Print): 2213-476X
ISSN (Online): 2213-4778

Research Article

Comparison of Maternal and Neonatal Outcomes in Case of Primary Cesarean Section Done During Late vs. Early Labor

Author(s): Heena Anuff, Zeinah Rahman, Rajani Dube* and Shatha Taher Salman Al-Zuheiri

Volume 7 , Issue 3 , 2020

Page: [244 - 253] Pages: 10

DOI: 10.2174/2213476X07666200708110738

Price: $65

Abstract

Background: Cesarean section (CS) done before the onset of labor is called an elective and done during labor is called an emergency CS. During labor, CS may be needed in early(1st) or late(2nd) stages. Earlier studies have shown more maternal and fetal complications when a cesarean is done for the first time in the late stages.

Objective: Our objective was to find out whether the maternal and fetal outcomes differ when primary CS is done in the first stage of labor compared to the second stage of labor for various indications and how.

Methods: This was a retrospective observational study on women who underwent primary CS during active labor and to link the maternal and fetal outcomes related to the stages of labor. The study population was patients admitted to the Labor ward of Saqr hospital, Ras Al Khaimah, UAE, between 1st January 2017 till 31st December 2017, but had to undergo primary CS during labor for various indications at 1st and 2nd stages of labor. Data was collected from maternal and neonatal electronic case records.

Results: A total of 135 case records were studied. Most cesarean sections were in the early stage of labor. The most common indications were fetal distress and prolonged labor. The maternal and fetal complications were higher in 2nd stage of labor than in 1st stage which includes uterine atonia (p=.001), postpartum hemorrhage (p=.006), postoperative hematuria(RR=3.46), problems with breastfeeding (p=0.001) and fetal injuries (p<.001).

Conclusion: Primary CS in late labor is associated with increased maternal and neonatal complications compared to CS in early labor.

Keywords: Outcome in early CS, outcome in late CS, maternal, neonatal outcomes, primary cesarean section, expulsion.

[1]
Dumont A, de Bernis L, Bouvier-Colle MH, Bréart G. MOMA study group. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet 2001; 358(9290): 1328-33.
[http://dx.doi.org/10.1016/S0140-6736(01)06414-5] [PMID: 11684214]
[2]
Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth 2006; 33(4): 270-7.
[http://dx.doi.org/10.1111/j.1523-536X.2006.00118.x] [PMID: 17150064]
[3]
Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep 2010; 30: 1-31.
[4]
Sandall J, Tribe RM, Avery L, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet 2018; 392(10155): 1349-57.
[http://dx.doi.org/10.1016/S0140-6736(18)31930-5] [PMID: 30322585]
[5]
Adinma J. Litigations and the obstetrician in clinical practice. Ann Med Health Sci Res 2016; 6(2): 74-9.
[http://dx.doi.org/10.4103/2141-9248.181847 ] [PMID: 27213088]
[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(4): 589-95.
[PMID: 10725495]
[7]
Seal SL, Kamilya G, Mukherji J, Bhattacharyya SK, De A, Hazra A. Outcome in second- versus first-stage cesarean delivery in a teaching institution in eastern India. Am J Perinatol 2010; 27(6): 507-12.
[http://dx.doi.org/10.1055/s-0030-1248936] [PMID: 20175041]
[8]
Tan PS, Tan JKH, Tan EL, Tan LK. Comparison of caesarean sections and instrumental deliveries at full cervical dilatation: a retrospective review. Singapore Med J 2019; 60(2): 75-9.
[http://dx.doi.org/10.11622/smedj.2018040] [PMID: 29670996]
[9]
Unterscheider J, McMenamin M, Cullinane F. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynecol Reprod Biol 2011; 157(2): 141-4.
[http://dx.doi.org/10.1016/j.ejogrb.2011.03.008] [PMID: 21470764]
[10]
Cebekulu L, Buchmann EJ. Complications associated with cesarean section in the second stage of labor. Int J Gynaecol Obstet 2006; 95(2): 110-4.
[http://dx.doi.org/10.1016/j.ijgo.2006.06.026] [PMID: 16934268]
[11]
Allen VM, O’Connell CM, Baskett TF. Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. BJOG 2005; 112(7): 986-90.
[http://dx.doi.org/10.1111/j.1471-0528.2005.00615.x] [PMID: 15958005]
[12]
Alexander JM, Leveno KJ, Rouse DJ, et al. National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol 2007; 109(4): 917-21.
[http://dx.doi.org/10.1097/01.AOG.0000257121.56126.fe] [PMID: 17400854]
[13]
Stanhope T, Tuuli M, Caughey A, Macones G, Cahill A. Mode of delivery and neonatal outcomes in nulliparas with a prolonged second stage. Am J Obstet Gynecol 2016; 214: 267-8.
[http://dx.doi.org/10.1016/j.ajog.2015.10.532]
[14]
Lenz F, Kimmich N, Zimmermann R, Kreft M. Maternal and neonatal outcome of reverse breech extraction of an impacted fetal head during caesarean section in advanced stage of labour: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19(1): 98.
[http://dx.doi.org/10.1186/s12884-019-2253-3] [PMID: 30917799]
[15]
Selo-Ojeme D, Sathiyathasan S, Fayyaz M. Caesarean delivery at full cervical dilatation versus caesarean delivery in the first stage of labour: comparison of maternal and perinatal morbidity. Arch Gynecol Obstet 2008; 278(3): 245-9.
[http://dx.doi.org/10.1007/s00404-007-0548-5] [PMID: 18189142]
[16]
Spong CY. Prediction and prevention of recurrent spontaneous preterm birth. Obstet Gynecol 2007; 110(2-1): 405-15.
[http://dx.doi.org/10.1097/01.AOG.0000275287.08520.4a] [PMID: 17666618]
[17]
Bosma E, Veen EJ, de Jongh MAC, Roukema JA. Variable impact of complications in general surgery: a prospective cohort study. Can J Surg 2012; 55(3): 163-70.
[http://dx.doi.org/10.1503/cjs.027810] [PMID: 22449724]
[18]
Kaplanoglu M, Karateke A, Un B, Akgor U, Baloğlu A. Complications and outcomes of repeat cesarean section in adolescent women. Int J Clin Exp Med 2014; 7(12): 5621-8.
[PMID: 25664081]
[19]
Nuttall FQ. Body mass index: obesity, bmi, and health: a critical review. Nutr Today 2015; 50(3): 117-28.
[http://dx.doi.org/10.1097/NT.0000000000000092] [PMID: 27340299]
[20]
WHO recommendations for augmentation of labour 2014. Executive summary Available from: https://www.ncbi.nlm.nih.gov/books/NBK258881/
[21]
WHO recommendations: induction of labour at or beyond term. Geneva: World Health Organization 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/277233/9789241550413-eng.pdf
[23]
WHO recommendations on prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization 2012. Available from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/
[24]
National Institute for Health and Care Excellence Caesarean Section (CG132). 2019. Available from: http://pathways.nice.org.uk/pathways/caesarean-section/retrieved from
[25]
Perlino CA. Postoperative fever. Med Clin North Am 2001; 85(5): 1141-9.
[http://dx.doi.org/10.1016/S0025-7125(05)70369-2] [PMID: 11565491]
[26]
Spinner MR. Maternal-infant bonding. Can Fam Physician 1978; 24: 1151-3.
[PMID: 21301556]
[27]
Razaz N, Cnattingius S, Persson M, Tedroff K, Lisonkova S, Joseph KS. One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada. BMJ Open 2019; 9(5)e027655
[http://dx.doi.org/10.1136/bmjopen-2018-027655] [PMID: 31072859]
[28]
Alexander JM, Leveno KJ, Hauth J, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Fetal injury associated with cesarean delivery. Obstet Gynecol 2006; 108(4): 885-90.
[http://dx.doi.org/10.1097/01.AOG.0000237116.72011.f3] [PMID: 17012450]
[29]
Belay T, Yusuf L, Negash S. A comparative study on first stage versus second stage caesarean section on maternal and perinatal outcome. Ethiop Med J 2014; 52(1): 1-8.
[PMID: 25069208]
[30]
Asıcıoglu O, Güngördük K, Yildirim G, et al. Second-stage vs. first-stage caesarean delivery: comparison of maternal and perinatal outcomes. J Obstet Gynaecol 2014; 34(7): 598-604.
[http://dx.doi.org/10.3109/01443615.2014.920790] [PMID: 24911878]
[31]
Sinha S, Malik S, Dixit M. First versus second stage caesarean section: a comparison of maternal and neonatal outcomes. Int J Reprod Contracept Obstet Gynecol 2017; 6: 3477-80.
[http://dx.doi.org/10.18203/2320-1770.ijrcog20173467]
[32]
Das S, Sarkar SK. Feto Maternal outcome in second versus first stage caesarean delivery in a Tertiary Rural Medical College. J Den Med Sci 2014; 13: 28-30.
[http://dx.doi.org/10.9790/0853-131212830]
[33]
Moodley J, Devjee J, Khedun S, Esterhuizen T. Second stage primary caesarean deliveries: are maternal complications increased? J South African Acad Fam Prac. Primary Care 2014; 51: 328-31.
[34]
Fyfe EM, Anderson NH, North RA, et al. risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term. J American Col of Obst and Gynecol 2011; 117: 1315-22.
[http://dx.doi.org/10.1097/AOG.0b013e318217922a]
[35]
Govender V, Panday M, Moodley J. Second stage caesarean section at a tertiary hospital in South Africa. J Matern Fetal Neonatal Med 2010; 23(10): 1151-5.
[http://dx.doi.org/10.3109/14767051003678002] [PMID: 20233130]
[36]
Lurie S, Raz N, Boaz M, Sadan O, Golan A. Comparison of maternal outcomes from primary cesarean section during the second compared with first stage of labor by indication for the operation. Eur J Obstet Gynecol Reprod Biol 2014; 182: 43-7.
[http://dx.doi.org/10.1016/j.ejogrb.2014.08.025] [PMID: 25218551]
[37]
Burke N, Burke G, Breathnach F, et al. Perinatal Ireland Research Consortium. Prediction of cesarean delivery in the term nulliparous woman: results from the prospective, multicenter Genesis study. Am J Obstet Gynecol 2017; 216(6)598.e1-59811
[http://dx.doi.org/10.1016/j.ajog.2017.02.017] [PMID: 28213060]
[38]
McDonnell S, Chandraharan E. Determinants and outcomes of emergency caesarean section following failed instrumental delivery: 5-year observational review at a tertiary referral centre in London. J Pregnancy 2015.2015627810
[http://dx.doi.org/10.1155/2015/627810] [PMID: 26078882]

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