Vol. 7, Issue 2, Part C (2025)

Background: Second-stage caesarean section (CS), performed after complete cervical dilatation, represents one of the most technically challenging obstetric procedures. It carries significantly higher maternal and neonatal risks compared with first-stage or elective CS. The increasing incidence of second-stage CS in tertiary care centres across India underscores the need to analyse its indications, intraoperative and postoperative complications, and perinatal outcomes to strengthen clinical management and improve patient safety.

Materials and Methods: This prospective observational study was carried out in a tertiary care teaching hospital from February 2022 to October 2022. All women undergoing caesarean section during the second stage of labour were included, comprising 69 cases out of 2,933 caesarean deliveries (2.35%). Data were collected from operative notes and patient records. Statistical analysis was performed using SPSS 22.0, Stata 17.0, and GraphPad software. Continuous variables were expressed as mean ± SD, and categorical data as frequencies and percentages. Associations were tested using Chi-square and t-tests, with p < 0.05 considered significant.

Results: Most women were primigravida (78.26%) with a mean age of 24.23±4.03 years. The leading indication for second-stage CS was fetal distress (33%), followed by obstructed labour (26%) and non-progress of labour (19%). Intraoperative complications were reported in 91.3% of patients, most frequently the need for blood transfusion (40.58%) and atonic postpartum haemorrhage (31.88%). Postoperative complications occurred in 92.75% of cases, with wound infection (40.57%) and prolonged catheterization (34.78%) being predominant. Neonatal complications were noted in 34.79% of cases, mainly meconium aspiration (20.29%) and respiratory distress (5.79%). No maternal deaths were recorded.

Conclusion: Second-stage caesarean section is associated with considerable maternal and neonatal morbidity. Early referral, vigilant intrapartum monitoring, and advanced surgical training are crucial to minimize complications and optimize fetomaternal outcomes.