Comparison of maternal and neonatal complications between first and second stage of labor cesarean deliveries at Mekelle public hospitals: a prospective cross-sectional study from February 2023 – June 2023

Background Cesarean delivery is a life-saving procedure, and it is increasing alarmingly in all setups even though it has overwhelming maternal and neonatal complications associated with it. Second-stage CDs are one of the difficult CDs with associated higher maternal and neonatal complications. The aim of the study is to compare the maternal and neonatal outcomes of cesarean delivery done at the second stage versus the first stage of labor. Method A cross-sectional comparative study was employed with data collected from patients' charts and interviews. All laboring mothers who underwent CD during the study period were included. After data collection, the information was first checked for completeness and then entered into EpiData, edited, coded, and subsequently exported into Statistical Package for Social Science (SPSS) for analysis. The data were presented in frequency tables and figures. Both descriptive and analytic statistical procedures were used. A p-value of < 0.05 was considered statistically significant at a 95% confidence interval, and the strength of association was measured using the odds ratio. Result A total of 4,654 deliveries were recorded, of which 1,005 (21.59%) were cesareans (CDs). Among these, 524 (52.14%) were performed during labor. Of the intrapartums, 433 (82.6%) occurred during the first stage of labor (group one), while 91 (17.36%) occurred during the second stage of labor (group two). Intraoperative complications were significantly more common in group two (17.6%) compared to group one (6.2%), with a P-value < 0.001. The most frequent complication in group two was extension, whereas in group one it was adhesion. Neonatal outcomes were also poorer in group two, with higher rates of low APGAR scores and NICU admissions. Additionally, the mean duration of the procedures was significantly longer in group two (58.07 minutes) compared to group on (47.29 minutes), also with a P-value < 0.001. Conclusion Women undergoing CDs in the second stage of labor experience increased maternal and fetal morbidity. These cases require special care and should be handled and operated on by experienced ones. Whenever possible, a neonatologist should be present during CDs performed in the second stage of labor. The complication rate can be reduced through early pelvic assessment during labor and timely intervention. Additionally, healthcare providers should anticipate the possibility of a second stage CD and prepare accordingly.