A comparative study on first stage versus second stage caesarean section on maternal and perinatal outcome

Background: Caesarean delivery (C/D) can be done in the first or second stage of labor. One fourth of the primary C/D are reported to be performed in the second stage of the labor but are more complicated compared to the ones performed in the first stage. Oobjective: To compare maternal and perinatal outcomes of caesarean delivery (C/D) performed in the second stage of labor compared with the first stage in the Ethiopian setting. Methods: An institution based comparative cross-sectional study was conducted in three teaching hospitals in Addis Ababa, Ethiopia. A sample size calculation for double proportion was used, and, for every second stage C/D, the next three consecutive first stage C/D cases were taken as controls till the desired sample size was achieved. mean and standard deviation for continuous and proportion for categorical variables were used for descriptive statistics. T-test for difference in independent mean and chi square test to compare proportions was utilized. Odds ratio with 95%CI was used to measure the strength of association of selected variables. Result: A total of 3238 deliveries were attended in the three teaching hospitals during the study period making the C/D rate of 30.1%. Three hundred eighty-eight emergency caesarean delivery cases were enrolled using the aforementioned technique with the proportion of 97(10.9%) second stage and 291(89.1%) first stage C/D .The most common indications in the first stage were non-reassuring fetal heart rate pattern (NRFHRP) accounting for 110 (37.8%) followed by arrest or protraction disorder of 68(23.4%), whereas the commonest indication for the second stage C/D was cephalopelvic disproportion 46(48.5%). Significant difference observed in the mean blood loss between the second stage and first stage C/D, 552 ml vs. 410 ml, (OR 30.13, 95%CI 16.25-55.85). Similarly, the women in the second stage C/D had longer mean hospital stay and mean longer operation time than first stage C/ D, 5.34 vs. 6.96 days, (OR 1.72, 95%CI 1.05-2.85), and 31.12 min vs. 37.5, (OR 2.33, 95%CI 1.33-4.07), respectively. Five caesarean hysterectomies were done for postpartum haemorrhage and four cases of extension of incision site were encountered following second stage C/D compared to none in the first stage C/D. Conclusion: Though no maternal death or significant perinatal complications were encountered, women with second stage C/D had significant maternal morbidities than first stage cesarean delivery. Therefore, utmost effort should be made to avoid the procrastination of the decision for C/D to the second stage, but if such compelling situations are encountered, precautions, like involvement of the most senior person and vigilance to minimize the expected complications is warranted.