Maternal and perinatal outcomes of cesarean Delivery during first-stage and second-stage of Labor at jimma medical centre, jimma, southwest Ethiopia

Abstract

BACKGROUND Cesarean delivery can be done in first stage of labor or second stage of labor. About 25% of primary cesarean deliveries are reported to be done in the second stage of labor. Maternal and perinatal outcome following cesarean delivery can be affected by different factors. Different studies have shown that both maternal and perinatal morbidity is higher when cesarean delivery is done in second stage of labor. OBJECTIVE: To compare maternal and neonatal outcomes when Cesarean Delivery is performed in second stage of labor with Cesarean Delivery done in first stage of labor. METHODS: A prospective cross-sectional comparative study was conducted from December 2020 to August 2021 in Jimma Medical Center, Obstetrics and Gynecology department on women who underwent first stage and second stage Cesarean Delivery. Total of 339 cases, 85- second stage and 254 first stage cesarean section cases were included in the study. RESULTS During the study period, there were 3,879 deliveries at JMC, and there were 1400 C/D making the hospital delivery rate 36.1%. Women in the second stage group had longer duration of surgery (44.89 min Vs 52.88 min) and operation took more than 50 minutes for 37(43.5%) of the second stage and 63(24.8%) of first stage group (p – 0.01, 95% CI 2.34(1.4-3.9). The mean blood loss was greater in the second stage group (618.82ml Vs473.82ml). The risk of blood loss more than 1000ml was higher in the second stage group (11.6% Vs 1.6%), p - 0.001, 95% CI 7.5(2.4- 23.2) . Women operated in second stage of labor had longer hospital stay (5.31 days Vs 3.70 days) than the first stage group: 33 mothers (38.8%) of the second stage and 33(13.0%) of the first stage group stayed more than four days in the hospital (p <0.001, 3.7 (2.2-6.3) ). Ten women of the second stage group (11.8%) required blood transfusion while only two of the first stage C/D group (0.7%) were transfused (p- 0.03, 95% CI 14.9(3.3-66.8). Puerperal Sepsis was more common in the second stage group ([8(3.15%) Vs 12(14.12&]) when compared with first stage group. NICU admission rate was higher for C/D in second stage of labor compared to the first stage C/D. Thirteen neonates (15.3%) of the second stage group and Eight (3.1%) of the first stage group had Fifth minute APGAR score <7 (p-0.003, 95% CI 4.9(2.1-11.3). Eight (16.33%) of neonates delivered to the second stage group and Eight (3.15%) of the first stage group ended up in ENND. CONCLUSION & RECOMMENDATION: The result of this study suggests that women undergoing cesarean section in the second stage of labor had increased maternal morbidities like blood loss, blood transfusion and prolonged hospital stay, Fifth minute APGAR Score < 7 was ii more common in the second stage C/D group, but the rate of NICU admission and ENND is not significantly different between the two groups