Abstract
Objective
To compare perinatal and maternal morbidity associated with caesarean sections performed in the first with that performed in the second stages of labour.
Patients and methods
Comparative analyses between nulliparous women with singleton term pregnancies who had a caesarean section in the first stage of labour and those who had a second stage caesarean section were completed using standard statistical methods. A subgroup analysis, according to indication for caesarean section, was also performed.
Results
Of 627 women, 81% had caesarean delivery in the first stage and 19% had caesarean delivery in the second stage of labour. Women undergoing caesarean delivery at full cervical dilatation were 1.9 times more likely to have an augmented labour (95% CI 1.2–3.4, P < 0.001) and 2.8 times more likely to have epidural anaesthesia in labour (95% CI 1.5–5.2, P < 0.001) than those in the first stage. Compared with caesarean delivery in the first stage of labour, women undergoing caesarean delivery at full cervical dilatation were 4.6 times more likely to have composite intraoperative complications (95% CI 2.7–7.9, P < 0.001), 3.1 times more likely to have blood loss greater than 1,000 ml (95% CI 1.3–7.4, P = 0.01), and 2.9 times more likely to have a blood transfusion (95% CI 1.5–5.6, P < 0.001). The risk of neonatal morbidity was higher in first stage caesareans when they were performed for presumed fetal compromise (66.3 vs. 26.3%, P = 0.002), and lower when they were performed for failure to progress (18.4 vs. 42%, P = 0.02).
Conclusion
Caesarean section in the second stage of labour is associated with a higher risk of maternal but not perinatal morbidity.
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References
Joseph KS, Young DC, Dodds L (2003) Changes in maternal characteristics and obstetric practice and recent increase in primary caesarean delivery. Obstet Gynecol 102:791–800
Lauer JA, Betrán AP (2007) Decision aid for women with previous caesarean section. BMJ 334:1281–1282
Betrán AP, Myriad M, Lauer JA, Bin-shun W, Thomas J, Van Look P (2007) Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 28:98–113
Dabbas M, Al-Sumadi A (2007) Caesarean section rate: much room for reduction. Clin Exp Obstet Gynecol 34(3):146–148
Lowe B (1987) Fear of failure: a place for trial of instrumental delivery. BJOG 94:60–66
Revah A, Ezra Y, Farine D, Ritchie K (1997) Failed trial of vacuum or forceps—maternal and fetal outcome. Am J Obstet Gynaecol 176:200–204
Murphy DJ, Liebling RE, Venity L, Swingler R, Patel R (2001) Early maternal and neonatal morbidity associated with operative delivery in the second stage of labour: a cohort study. Lancet 358:1203–1207
Murphy DJ, Liebling RE, Patel R, Venity L, Swingler R (2003) Cohort study of operative delivery in the second stage of labour and standard obstetric acre. BJOG 110:610–615
Burrows LJ, Meyn LA, Weber AM (2004) Maternal morbidity associated with vaginal versus caesarean delivery. Obstet Gynecol 103(5 Pt 1):907–912
Liebling RE, Swingler R, Patel RR, Verity L, Soothill PW, Murphy DJ (2004) Pelvic floor morbidity up to one year after difficult instrumental delivery and caesarean section in the second stage of labour: a cohort study. Am J Obstet Gynecol 191:200–204
Liu S, Heaman M, Joseph KS, Liston RM, Huang L, Sauve R, Kramer MS (2005) Risk of maternal postpartum readmission associated with mode of delivery. Obstet Gynecol 105(4):836–842
Allen VM, O’Connell CM, Baskett TF (2006) Maternal morbidity associated with caesarean delivery without labour compared with induction of labour at term. Obstet Gynecol 108(2):286–294
Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS, Maternal Health Study Group of the Canadian Perinatal Surveillance System (2007) Maternal mortality and severe morbidity associated with low-risk planned caesarean delivery versus planned vaginal delivery at term. CMAJ 176(4):455–460
Office of National Statistics. Caesarean deliveries in NHS hospitals: Social Trends 34. http://www.statistics.gov.uk/StatBase/ssdataset.asp?vlnk=7412&More=Y
Allen VM, O’Connell CM, Baskett TF (2003) Maternal morbidity associated with caesarean delivery without labour compared with spontaneous onset of labour at term. Obstet Gynecol 102:477–482
Allen V, O’Connell C, Baskett T (2005) Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. BJOG 112:986–990
Cebekulu L, Buchmann EJ (2006) Complications associated with caesarean section in the second stage of labour. Int J Gynecol Obstet 95:110–114
Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner R, Sorokin Y, Miodovnik M, O’Sullivan MJ, Sibai BM, Langer O, Gabbe SG (2007) Comparison of maternal and infant outcomes from primary caesarean delivery during the second compared with first stage of labour. Obstet Gynecol 109(4):917–921
Lewis G (2004) Why mothers dies 2000–2002: confidential enquiries into maternal and child health. RCOG Press, London pp 37–40
Janni W, Schiessl B, Peschers U, Huber S, Strobl B, Hantschmann P, Uhlmann N, Dimpfl T, Rammel G, Kainer F (2002) The prognostic impact of a prolonged second stage of labour on maternal and fetal Outcome. Acta Obstet Gynecol Scand 81(3):214–221
National Institute for Health and Clinical Excellence (2007) Intrapartum care, London
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The following assisted in some data collection: Dr. Rhonda Fleming and Dr. Ora Jesna.
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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 278, 245–249 (2008). https://doi.org/10.1007/s00404-007-0548-5
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DOI: https://doi.org/10.1007/s00404-007-0548-5