First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis.
The rates of cesarean section at full cervical dilatation (second stage cesarean sections) are currently increasing. The purpose of the present study is to compare maternal and neonatal morbidity and mortality among cases offered cesarean section at full dilatation to those offered cesarean section prior to full dilatation. We searched Medline, Scopus, Clinicaltrials.org, Popline, Cochrane CENTRAL, and Google Scholar search engines, along with reference lists from all included studies. The RevMan 5.0 software was used for all analyses. Primary maternal outcomes were defined as death, ICU admission and need for transfusion, while primary neonatal outcomes were defined as death, neonatal unit admission and 5min Apgar score less than 7. Ten studies were finally retrieved involving 23,104 singleton childbearing women (18,160 operated in the first stage and 4944 in the second stage of labor). Second stage cesarean section seems to lead to higher maternal admissions to ICU (OR 7.41, 95% CI 2.47-22.5) and higher transfusion rates (OR 2.60, 95% CI 1.49-2.54). Neonatal death rates were also increased (OR 5.20, 95% CI 2.49-10.85) along with admissions to neonatal unit (OR 1.63, 95% CI 0.91-2.91) and rates of Apgar score less than 7 in 5min (OR 2.77, 95% CI 1.02-7.50). Second stage cesarean section seems to result significantly increased morbidity for both mothers and neonates. It seems that a direct evaluation with forceps and vacuum extractors is imperative in order to establish its place in modern evidence-based practice.
1st Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, 80, Vasilisis Sofias Avenue, Greece. Electronic address: pergialiotis@yahoo.com.
Vasileios
V
Pergialiotis
1st Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, 80, Vasilisis Sofias Avenue, Greece.
Dimitrios G
DG
Vlachos
1st Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, 80, Vasilisis Sofias Avenue, Greece.
Alexandros
A
Rodolakis
1st Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, 80, Vasilisis Sofias Avenue, Greece.
Dimitrios
D
Haidopoulos
1st Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, 80, Vasilisis Sofias Avenue, Greece.
Nikolaos
N
Thomakos
1st Department of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital, 80, Vasilisis Sofias Avenue, Greece.
Georgios D
GD
Vlachos
D002585:Cesarean Section / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007747:Labor Stage, First; D007748:Labor Stage, Second; D011247:Pregnancy
Cesarean section; Maternal; Morbidity; Neonatal; Second stage