title: Comparison of maternal outcomes from primary cesarean section during the second compared with first stage of labor by indication for the operation.
abstract: OBJECTIVE
  To compare maternal outcomes when cesarean sections were performed in the second stage of labor to those performed in the first stage of labor by indication for the operation.
  
  
  METHODS
  This is a retrospective cohort (n=383) of term parturient women who underwent primary cesarean section during active labor. Cases were drawn from the Obstetrics Department, E. Wolfson Medical Center, a tertiary health care university facility, during a 24 month period. All cases were term singleton pregnancies in vertex presentation following unremarkable pregnancy. Maternal morbidity was assessed.
  
  
  RESULTS
  A significantly higher rate of unintentional uterine incision extensions was observed in cesarean sections performed during second stage compared to first stage (17.1% vs. 4.6%, p=0.001). It was higher whenever (at first or second stage) the fetal head was pushed (20.0% vs. 5.4%, p=0.0024). Unintentional uterine incision extensions were significantly more frequent when the cesarean section was performed for non-progressive labor during the second stage compared to first stage (16.1% vs. 3.6%, p=0.0052). Uterine atonia was more frequent among parturient women who underwent cesarean section for non-progressive labor during the first stage compared to second stage (16.7% vs. 4.8%, p=0.0382).
  
  
  CONCLUSIONS
  Uterine atony during first stage cesarean section and unintentional uterine incision extensions during second stage cesarean section were significantly more frequent when the operation was performed for non-progressive labor.
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: drslurie@hotmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lurie
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Nili
authors.initials: N
authors.lastname: Raz
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Epidemiology and Statistics Unit, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Oscar
authors.initials: O
authors.lastname: Sadan
authors.affiliation: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Golan
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005316:Fetal Distress / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007747:Labor Stage, First; D007748:Labor Stage, Second; D061646:Operative Time; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000601:surgery; D014593:Uterine Inertia / Q000209:etiology; D055815:Young Adult
keywords: Cesarean section; Labor; Maternal morbidity; Stages of labor