title: A comparative study on first stage versus second stage caesarean section on maternal and perinatal outcome.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Terefayehu
authors: T
authors: Belay
authors: Lukman
authors: L
authors: Yusuf
authors: Shiferaw
authors: S
authors: Negash
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007747:Labor Stage, First; D007748:Labor Stage, Second; D007902:Length of Stay / Q000706:statistics & numerical data; D061646:Operative Time; D006473:Postpartum Hemorrhage / Q000601:surgery; D011247:Pregnancy; D055815:Young Adult