Publication:

A study of second stage caesarean sections at term

Background Caesarean section (CS) in the second stage of labour is a technically demanding procedure associated with significant maternal and neonatal morbidity. Its rising incidence, driven by declining use of instrumental vaginal delivery and increasing medicolegal concerns, makes it an important area of study. This study aimed to assess the incidence, indications, intraoperative and postoperative complications, and fetomaternal outcomes of second stage CSs at a tertiary care teaching hospital in North India.

Methods A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Christian Medical College and Hospital (CMCH), Ludhiana. Obstetric records of all patients who underwent CS in the second stage of labour between 1st January 2018 and 30th June 2020 were reviewed and analysed.

Results Of 1372 total CSs performed during the study period, 103 (7.5%) were in the second stage of labour. The majority of women (79.6%) were aged 21-30 years; 66% were primigravidae. Induced labour was present in 56.3% of cases. Cephalopelvic disproportion was the most common indication (33.3%), followed by fetal distress (22.9%). The head push method was used in 71.8% of cases for delivery of the impacted fetal head. Uterine atony was the most common intraoperative complication (21.3%). The majority of women (72%) had no postoperative complications. Fifty-eight percent of neonates had no complications; birth asphyxia (10.7%) and meconium aspiration syndrome (6.8%) were the most common neonatal morbidities.

Conclusions Second stage CS is associated with significant fetomaternal morbidity. Proactive antenatal assessment, judicious intrapartum management, and structured training in operative vaginal delivery and fetal head disimpaction techniques are essential to reduce its incidence and associated complications.