Comparison of maternal and neonatal outcomes following caesarean section in second versus first stage of labour in a Tertiary Hospital in Nigeria

Abstract

Aims and objectives: To compare maternal and neonatal outcomes between caesarean section performed in the first and second stages of labour at the maternity unit of the Lagos State University Teaching Hospital, Lagos, Nigeria.

Materials and methods: Patients hospital records from 1st January 2008 to 31st December 2009 were examined. Data were extracted using a structured proforma. Information on demographics, intrapartum and intraoperative characteristics as well as selected maternal and neonatal outcomes were obtained. Comparative analysis was done using the student t test for continuous variables and the chi- square with Yates correction or the Fisher exact test for categorical variables.

Results: Of the 347 caesarean deliveries available for analysis, 245 (70.6%) were performed in the first stage while 102 (29.4%) were performed in the second stage of labour. Women who had caesarean deliveries performed in the second stage were more likely to be referred rather than institutional patients (p< 0.001), to have longer operative time, higher blood loss, more cases of intraoperative trauma, primary post partum haemorrhage, blood transfusion, re-look laparotomy, hysterectomy, post op pyrexia, wound infection and longer hospital stay (all with p value <0.05). Infants born to women who had caesarean section in the second stage of labour, had higher incidence of birth asphyxia, admission to neonatal intensive care unit, sepsis, seizure, need for ventilation and neonatal death (all with p value <0.05).

Conclusion: Caesarean section in the second stage of labour is associated with significantly increased maternal and neonatal morbidity as well as increased neonatal mortality.