Publication:

The indications, intraoperative complications, maternal and fetal outcomes in second-stage cesarean section at full dilation

Background Second-stage caesarean section (SSCS), performed at full cervical dilatation, is associated with increased maternal and neonatal morbidity owing to technical difficulties d9uring fetal extraction. This study aimed to evaluate the indications, intraoperative complications and maternal and neonatal outcomes of SSCS.

Methods A prospective observational study was conducted among 73 term pregnant women who underwent second-stage caesarean section at a tertiary care teaching hospital over one year. Maternal demographic characteristics, indications for surgery, intraoperative and postoperative complications and neonatal outcomes were recorded and analysed. Associations were evaluated using the Chi-square test with p<0.05 considered significant.

Results The commonest indication for SSCS was arrest of descent/cephalopelvic disproportion (67.1%). Intraoperative complications occurred in 49.3% of women, with uterine angle extension being the most frequent (32.9%). Postoperative complications occurred in 50.7%, predominantly postoperative infection (38.4%). Neonatal complications were observed in 52.1%, with respiratory distress syndrome being the commonest (39.7%). The Patwardhan technique was significantly associated with increased intraoperative complications (p=0.013), while operative duration exceeding one hour was significantly associated with postoperative complications and infections (p=0.001).

Conclusions Second-stage caesarean section is associated with substantial maternal and neonatal morbidity. Early recognition of labour abnormalities, timely intervention and appropriate surgical techniques may reduce adverse outcomes.