Abstract:
Currently cesarean section is an increasing mode of childbirth. Although the safety of
cesarean section is well documented, decision-making surrounding caesarean section in the second stage
of labor is one of the great challenges in current obstetric practice. In addition, there is limitation of data
regarding maternal and perinatal morbidity after cesarean section at full cervical dilatation study area.
Objective: To determine maternal and neonatal outcomes and associated factors comparing cesarean
delivery performed in second stage of labor with those C/S conducted in first stage of labor from September
1, 2024 to December 31, 2024 in Hiwot Fana Comprehensive specialized University Hospital.
Methods: A prospective cohort study was conducted from September 1 to December 31 2024 in Hiwot
Fana Comprehensive Specialized Hospital. Using Epi stat calc 7 for cohort study that utilized blood loss of
> 500ml as an outcome variable 236 women were selected. 59-second stage and 177 first stage cesarean
section cases were included in the study, using ratio of 1:3. Structured face-to-face interviews questioners
supplemented with review of both maternal and neonatal charts were used to collect information. The
collected data were entered into Epi-data version 4.6 and exported to SPSS version 22 for further analysis.
Binary logistic regression and multivariable logistic regression analyses were done to identify factors
independently associated with poor maternal and neonatal outcomes and statistical significance was
declared at a p-value of <0.05.Over all maternal complication of second stage group was 54.2% (95%CI=42.9-58.9) compared
to 21.4% (95%CI=18.1-25.6) for first stage group. Among mothers who underwent Cesarean Delivery,
75% had no known gestational age. The overall neonatal complication of second stage group was 32%
compared to 10% for first stage and most common fetal complication was early onset neonatal sepsis
(11.9%). Level of residency, station of fetal presenting part and method of fetal extraction were found to
be significantly associated with maternal complications.
Conclusion: Composite maternal and neonatal morbidities were increased when CD was done at second
stage compared to first stage cesarean deliveries. Level of the surgeon, station of fetal presenting parts and
method of fetal extraction is independently associated with adverse maternal outcomes while indication for
cesarean delivery, status of liquor and duration of ROM is strongly associated with neonatal outcomes.
Recommendations: The most senior residents should be involved in the management of second stage
cesarean section, anticipation for need of neonatal resuscitations in second stage of labor should be made,
especially for those with associated factors, and necessary preparations should be made.
