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Updated: Jun 9, 2025

External Cephalic Version: Is it an Effective and Safe Procedure?
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Emergent cesarean section during active labor-does cervical dilatation matter?

Gil Shechter Maor1,2, Ziv Shapira2, Chen Manor Bar1,2

  • 1Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, Israel.

Archives of Gynecology and Obstetrics
|October 22, 2024
PubMed
Summary

Emergent cesarean sections at complete dilation increase risks of uterine atony and incision extension. Performing cesarean sections during active labor is associated with fewer complications for mothers and newborns.

Keywords:
Cervical dilatationCesarean sectionEmergent deliveryLabor stagesMaternal complicationsNeonatal outcomes

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Area of Science:

  • Obstetrics and Gynecology
  • Surgical Outcomes Research

Background:

  • Cesarean sections (CS) are common surgical procedures.
  • The timing of emergent CS during labor may influence maternal and neonatal outcomes.
  • Understanding complication rates based on labor stage is crucial for clinical decision-making.

Purpose of the Study:

  • To compare immediate and late complications of emergent cesarean sections (CS) performed during the first stage of active labor versus at complete cervical dilatation.
  • To evaluate maternal and neonatal outcomes in relation to the timing of emergent cesarean delivery.

Main Methods:

  • Retrospective analysis of electronic medical records from 577 patients undergoing emergent CS at 4 cm or more cervical dilatation.
  • Patients were stratified into two groups: CS during the first stage of labor (4-9 cm) and CS at complete dilatation (10 cm).
  • Comparison of maternal complications (uterine atony, hemorrhage, infection) and neonatal outcomes (NICU admission).

Main Results:

  • The complete dilatation group had significantly higher rates of uterine atony (19.6% vs. 11.6%) and uterine incision extension (34.2% vs. 16.5%).
  • Longer hospital stays (4.8 vs. 4.25 days) and higher readmission rates for infection-related complications were observed in the complete dilatation group.
  • No significant differences in neonatal outcomes, such as APGAR scores or NICU admissions, were found between the groups.

Conclusions:

  • Emergent cesarean sections at complete cervical dilatation are linked to increased intra-operative and post-operative complications.
  • Performing cesarean delivery during active labor may mitigate risks for both mother and neonate.
  • Clinical consideration of labor stage is vital for optimizing cesarean delivery outcomes.