Rashid, Nurul Nafizah Mohd
(2018)
A 6-year review of maternal outcomes for second stage cesarean section in Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Objectives: To determine the prevalence of cesarean section performed in the second
stage of labour and to identify the maternal outcomes and its associated risk factors in
these women.
Study design: This retrospective study was carried out in the Hospital University Sains
Malaysia (HUSM). Medical records of 207 women with singleton cephalic pregnancies
at term, identified from the hospital database, who underwent a second stage cesarean
section (SSCS) between 1st January 2010 and 31st December 2015, were reviewed and
demographic and outcome data were collected.
Results: During the study period 8197/42,546 (19.3%) babies were delivered by CS.
Two hundred and fifty seven CS (4.1%) were performed in the second stage of labour.
Almost half of the women were nulliparous (49.3%) and 87.9% had spontaneous labour
and 59.4% (n=123) had oxytocin augmentation. There were 48 (23.2%) whom had
previous cesarean sections and 147 (71.1%) had the station below zero (62.3%, 7.7%
and 1.0% for station 0, +1 & +2 respectively). 85.5% of women had a second stage CS
without a trial of instrumental delivery. The mean duration of second stage in this study
was 144 (±56.2) minutes and mean estimated blood loss was 545 (±357) mls. 12.6% of
women (n=26) had postpartum hemorrhage (greater than or equal to 1000mls). 10.6%
(n=22) of these women required blood transfusion. Only 1 woman (0.5%) need to be
admitted to intensive care unit post-operatively. 78.7% (n=163) had the overall length
of hospital stay for 3 days. 18.4% (38) and 15.9% (33) of women had extended uterine
tear and uterine atony respectively. Otherwise none of the women sustained neither
cervical tear nor bladder injury. The parity (p<0.001), attempted instrumentation
(p<0.001), and baby weight (p<0.004) were statistically significant association with the
total blood loss. The risk factors for extended uterine tear was statistically significant
associated with parity (p<0.012) and attempted instrumentation (p<0.001) respectively.
Conclusions: The overall outcomes of second stage CS performed in HUSM is
comparable to studies done in other centres. Current practices need to be maintained or
improved especially with regards to meticulous documentation and training of junior
obstetric staff to provide the best care for the patients.
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