Feto-maternal outcome in second stage caesarean section in a tertiary care hospital

Methodology: The study was conducted in the Post graduate department of Obstetrics and Gynaecology of Lalla Ded Hospital, GMC Srinagar, a tertiary care centre over a period of 18 months. 100 caesarean sections performed on 100 female subjects in second stage of labor were included in this study based on inclusion criteria. Data Collection: Obstetrical, maternal and fetal baseline criteria and outcomes were recorded and compared.All the cases, that fulfilled the inclusion criteria were analyzed in terms of indications, instrumentation before caesarean section; intra operative complications like hematuria, uterine incision extension, lower uterine segment tear, atonic PPH; postoperative complications like febrile illness, wound infection; and neonatal morbidity and mortality by way of NICU admission, APGAR score, neonatal sepsis and stay in the hospital. Results The mean maternal age at presentation was 24.66 (± 3.42) years with the range from 17 to 35 years. Maximum number of cases were seen between the age group of 20-25 years (58; 58 %), followed by 25-30 years (28; 28%).Out of 100 pregnancies, 74 were primigravida and 26 were multigravida pregnancies.The gestational age was between 37-39 weeks in 94 deliveries and only 6 deliveries were above 40 weeks. The mean gestational age was 37.94 ± 1.03 weeks. Majority of patients belonged to Low Socioeconomic group (64; 64%) followed by Middle Socioeconomic group (34; 34%). Conclusion: Caesarean section in the second stage of labor is a challenging operation with distortion of pelvic anatomy and a fetal head that is often deeply impacted in the maternal pelvis. So, proper fetal and pelvic assessment should be done to assess the potential impact of the fetus on the characteristics of the labor and every attempt should be made to avoid second stage caesarean section, if possible. When faced with difficult decisions relating to the management, a second opinion from a senior obstetrician should be sought. If second stage caesarean section is unavoidable, a multidisciplinary approach should be followed involving a senior anaesthetist, a senior obstetrician and a neonatologist