Incidence, Risk factors, Maternal and Neonatal Outcomes of Second-stage Cesarean Section at Siriraj Hospital

Objectives: To determine the incidence of cesarean section (CS) during second stage of labor, to evaluate maternal and neonatal outcomes, and to determine risk factors. Materials and Methods: A retrospective cohort study was conducted in 636 women with term, singleton pregnancies with cephalic presentation who delivered during January to April 2021. Data were extracted from medical records, including baseline, antenatal care data, mode of deliveries and outcomes. The incidence of 2^nd stage CS was estimated. Maternal and neonatal outcomes were compared between different modes of deliveries. Results: Overall CS rate was 28.5% with 22.8% occurred during 1^st stage and 5.7% had CS during 2^nd stage of labor. CS during 2^nd stage of labor contributed to 19.9% of all CS. Instrumental vaginal delivery was performed in only 5.5%. Those with 2^nd stage CS were more likely to be overweight or obese, and to have gestational weight gain above recommendation. The most common indication for CS was cephalopelvic disproportion. Neonatal birth weight and rate of macrosomia were significantly higher among those with 2^nd stage CS while birth asphyxia was more common among 1^st stage CS. Other maternal and neonatal outcomes were comparable. Conclusion: CS during second stage of labor occurred in 5.7% of all women, contribution to 19.9% of all CS. Those with 2^nd stage CS were more likely to be overweight and obese, to have excessive gestational weight gain, and to have higher neonatal birth weight and rate of macrosomia. There was no increase in serious adverse outcomes in women with 2^nd stage CS.