title: Cesarean delivery during second-stage labor: characteristics and diagnostic accuracy.
abstract: OBJECTIVE
  To characterize dysfunctional labors that lead to cesarean delivery in the second stage and to assess the accuracy of diagnoses of abnormal fetal descent.
  
  
  METHODS
  Thirty-one patients delivered by cesarean during the second stage because of abnormal labor or presumed cephalopelvic disproportion were studied and compared to 62 control cesarean cases delivered for the same indications in the first stage. The clinical diagnosis of dysfunctional labor that led to the cesarean was compared to the diagnosis made by retrospective analysis of the labor curves.
  
  
  RESULTS
  Cases did not differ from controls delivered in the first stage in maternal age, race, parity, gestational age, weight gain, or the frequency of associated medical complications. The newborns were not significantly different in birth weight,ponderal index, sex, or the incidence of low Apgar scores. Among study patients, 94% had a second stage labor dysfunction determined by graphic labor analysis, predominantly arrest of descent (69%) and failure of descent (28%). In 79% of cases a dysfunctional first stage preceded the abnormal second stage. Among these first stage labor abnormalities, 68% were not recognized during the labor.
  
  
  CONCLUSIONS
  Characteristics of patients delivered by cesarean during the second stage were similar to those delivered before full cervical dilatation. Second stage labor abnormalities were usually preceded by an abnormal first stage. There was considerable inaccuracy in the diagnosis of second stage labor dysfunction.
authors.affiliation: Department of Obstetrics, Jamaica Hospital Medical Center and Weill-Cornell Medical College, New York, New York, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Garrett
authors.forename: Allison
authors.initials: A
authors.lastname: Butler
authors.forename: Wayne R
authors.initials: WR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000175:diagnosis*; D011247:Pregnancy; D012189:Retrospective Studies