Second stage caesarean section at a tertiary hospital in South Africa

An audit of second stage caesarean section (C/S) at a tertiary hospital was undertaken to compare the frequency of perinatal and maternal complications between first and second stage C/S and to evaluate the training level of physicians.

A prospective chart audit of all women who underwent emergency C/S over a 7-month period at a tertiary hospital was conducted. The patients' hospital records were assessed on a daily basis and all relevant information recorded on a structured data sheet categorising demographics, indications for C/S, level of training of decision-maker and surgeon, a consultant's presence, operative complications and neonatal outcome at 5 min post-delivery. The frequency of maternal and neonatal complications was the main outcome measures.

There were 975 first stage and 116 second stage C/S. The commonest causes of second stage C/S were cephalo-pelvic disproportion, prolonged second stage and fetal distress. First stage C/S took a mean time of 35.5 min, while second stage C/S took an average time of 41.6 min to perform (p=0.001). There were 37 and 84 records of complications occurring in first and second stage C/S, respectively.

Maternal complications were significantly higher in second stage C/S while neonatal complications were not significantly different between first and second stage C/S. There was little guidance from consultants at decision-making for second stage C/S.