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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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– June 2023 Haftom Guesh Girmay, Musie Negasi Gebreslase, Birhanu Kassie Reta, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6957859/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract 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. Emergency cesarean delivery cesarean delivery done in labor second-stage cesarean delivery maternal complication neonatal complication Figures Figure 1 Figure 2 1. INTRODUCTION The most common major abdominal surgery performed on women worldwide is cesarean delivery (CD) ( 1 ). When medically indicated, it can save the mother's and the fetus's lives, but its rising prevalence has raised concerns, especially in low- and middle-income countries (LMICs), where resources are frequently ( 2 – 7 ). CD rates have increased dramatically over the last few decades in both high-income and resource-constrained environments, including Ethiopia. Rates have surpassed 50% in certain middle-income nations, and pooled estimates place Ethiopia's national CD rate at about5% ( 8 – 15 ). Compared to first-stage or elective CDs, cesarean deliveries that occur during the second stage of labor, when full cervical dilatation has been reached, present particular difficulties and are linked to increased maternal and neonatal mortality ( 5 , 6 ). Because of the deeply engaged fetal head, higher risk of bleeding, damage to nearby pelvic structures, longer operating times, and more frequent postoperative complications, second-stage CDs are technically more ( 16 – 20 ). Additionally, there is an increased risk of birth asphyxia, low APGAR scores, and admission to the neonatal intensive care unit (NICU) for babies delivered via second-stage D ( 19 ). According to recent studies, there is a global trend toward an increase in second stages ( 21 – 28 ). This trend is ascribed to a number of factors, including a lack of training in operative vaginal deliveries, heightened medicolegal concerns, and delayed labor decision-making ( 7 ). Similar to worldwide patterns, a sizable percentage of CDs are performed during labor ( 15 ). Nevertheless, there is still a dearth of local data and context-specific management guidelines for second-stage CDs, despite their increasing prevalence and clinical significance. (Fig. 1) By comparing the maternal and neonatal outcomes of first-stage versus second-stage cesarean deliveries in public hospitals in Mekelle, Ethiopia, this study seeks to close this disparity. In order to improve results, the findings are meant to support appropriate counseling of mothers and families, improve provider training, guide clinical decision-making, and aid in the creation of regional referral and protocol systems. Figure 1: conceptual frame work 2. METHODS AND MATERIALS 2.1. Study area and Period This study was conducted at Ayder Comprehensive Specialized Hospital (ACSH) and Mekelle General Hospital (MGH), both located in Mekelle, Northern Ethiopia. ACSH is the largest tertiary public hospital in the country, serving a catchment population exceeding 8 million people across the Tigray, Afar, and northern Amhara regions. The hospital provides a wide range of healthcare services, including specialized obstetric and gynecologic care, and is equipped with 78 inpatient beds, four delivery couches, two emergency rooms, one procedure room, a meeting hall, and dedicated operating and recovery rooms. MGH, affiliated with ACSH, functions as a teaching hospital, primarily for obstetrics and gynecology residents and senior physicians from ACSH. The study was carried out over a period of five months from February 1, 2023 to June 30, 2023 2.2. Study Design and Population A facility-based cross-sectional prospective study design was employed. The source of population consisted of all laboring mothers who delivered at either ACSH or MGH during the study period. The study population included all laboring mothers who underwent cesarean delivery at the two hospitals. Among them, women who met the eligibility criteria—those who underwent cesarean delivery during labor and provided informed consent—were included as study subjects. 2.3. Eligibility criteria The inclusion criteria covered all mothers who underwent cesarean delivery during labor in either hospital within the study timeframe. Mothers with a pre-diagnosed case of uterine rupture were excluded from the study to ensure uniformity in clinical conditions evaluated. 2.4. Sampling procedure A total population sampling approach was used, whereby all women who underwent intrapartum cesarean delivery during the study period were included, ensuring comprehensive data collection. 2.5. Study variables The primary dependent variables were adverse maternal and neonatal outcomes. Independent variables included maternal age, residence (urban or educational status, occupation, marital status, antenatal care (ANC) attendance, parity, previous mode of delivery, stage of labor at the time of cesarean, indications for cesarean, decision-maker (status of professional), the surgeon who performed the operation, and fetal condition at the time of decision. 2.6. Data Collection Process Eligible laboring mothers were identified in the labor and delivery wards of both hospitals. Upon obtaining informed consent, trained residents and interns collected data through structured interviews and medical chart reviews. Data were gathered using a combination of patient interviews and review of clinical records to ensure accuracy and completeness. ( Questionnaire uploaded as a supplementary file ) 2.7. Data Processing and Analysis Data collected were first reviewed by the principal investigator (PI) for completeness and consistency. Subsequently entered into EpiData software and exported into SPSS for statistical analysis. Both descriptive and inferential statistics were used, with results presented in frequency tables and figures. A p-value of < 0.05 was considered statistically significant. 2.8. Data Quality Assurance To ensure data quality, a pretest involving 5% of the study population was conducted. All data collectors received training on proper data collection techniques and ethical considerations. The PI closely supervised the data collection process to ensure adherence to protocol and timely documentation. 2.9. Operational Definitions Several key operational definitions were utilized in this study. “Residents referred to physicians in specialty training, with “ junior residents ” being in their first two years and “senior residents” in their final two years of the program. ” Seniors ” were fully trained specialists. An emergency cesarean delivery ” was defined as a cesarean performed while the mother was in labor, and a “ second-stage cesarean delivery “referred to procedures carried out after full cervical dilation. ” Primigravida “referred to a woman giving birth for the first time, while “ multigravida “included women who had given birth more than once. A prolonged second stage ” was defined as more than 2 hours in primigravida and more than 1 hour in multigravida.’ Maternal complications ” included any adverse outcomes up to 10 days postpartum, and “ neonatal complications “included any adverse events occurring within 7 days of birth. The “ last normal menstrual period (LNMP) ” and “ early ultrasound “(performed before 24 weeks of gestation) were also noted for gestational age assessment. Classification of residence as urban or rural was based on regional government criteria. 2.10. Ethical Consideration Ethical clearance for the study was granted by the institutional review board of Mekelle University, College of Health Science, with ethical approval number of MU-IRB 2063/2023. To ensure confidentiality, no personal identifiers were collected and were anonymized. Data were stored securely in locked cabinets and password-protected files. Participation in the study was voluntary, and informed consent was obtained from all participants. 3. RESULT Overview of deliveries and study group classification Out of 4,654 total deliveries recorded during the study period ,1005 (21.59%) were cesarean deliveries (CDs). Among these ,524 (52.14%) were conducted during labor. Of the intrapartum CDs, 433 (82.6 %) occurred during the first stage of labor (Group one), while 91 (17.36%) were conducted during second stage of labor (Group two). (Figure 2) 3.1. Socio-demographic characteristics and obstetric history The majority of mothers in both groups were aged 25-29 years (38.6 % in group one and 40.7% in group two). The mean age of mothers in group one was 27.5 years with a standard deviation of 5.2, and in group two, the mean ages were 27.5 ± 5.2 and 27.6 ± 5 years, respectively. Most mothers were urban residents (85.5% in group one and 79.1 % in group two), and all of the mothers were from Tigray except 1, who is from Afar. Nearly all participants were married and Christian, with a small percentage being single or divorced. A substantial proportion of mothers were referred from other institutions, particularly in group two (60.4% vs. 44.3% in group one). Literacy rates exceeded 94% in both groups, and unemployment was common (63.5%d 63.5%, respectively). Group one had a higher proportion of multigravida (50.6 %), while Group two had more primigravidas (52.7%). A third of mothers in group one had CD previously compared to 22% in group two, largely because the latter were more likely to be primigravida. Rates of previous abortion were similar between groups (6.9% vs. 8.8%). (Table 1) Table 1 : socio-demographic characteristics and Obstetric history Maternal characteristics First (N=433) Second (N=91) P value N % [95% CI] N % [95% CI] Age category <20 20 4.6 [2.9,6.9] 5 5.5 [2.1,11.6] 0.563 20-24 114 26.3 [22.4,30.6] 19 20.9 [13.5,30.1] 25-29 167 38.6 [34.1,43.2] 37 40.7 [31.0,50.9] 30-34 71 16.4 [13.1,20.1] 20 22.0 [14.4,31.3] ≥35 61 14.1 [11.1,17.6] 10 11.0 [5.8,18.6] Address Rural 63 14.5 [11.5, 18.1] 19 20.9 [13.5, 30.1] 0.131 Urban 370 85.5 [81.9, 88.5] 72 79.1 [69.9, 86.5] Religion Christian 416 96.1 [93.9, 97.6] 91 100.0 0.55 Muslim 17 3.9 [2.4, 6.1] 0 0.0 Marital status Single 20 4.6 [2.9, 6.9] 7 7.7 [3.5, 14.5] 0.56 Married 410 94.7 [92.3, 96.5] 84 92.3 [85.5, 96.5] Divorced 2 0.5 [0.1, 1.5] 0 0.0 Widowed 1 0.2 [0.0, 1.1] 0 0.0 Referral Self-referred 87 20.1 [16.5, 24.1] 19 20.9 [13.5, 30.1] 0.005 Referred 192 44.3 [39.7, 49.0] 55 60.4 [50.2, 70.0] Had follow up 154 35.6 [31.2, 40.2] 17 18.7 [11.7, 27.6] Educational status Illiterate 24 5.5 [3.7, 8.0] 4 4.4 [1.5, 10.1] 0.658 Literate 409 94.5 [92.0, 96.3] 87 95.6 [89.9, 98.5] Occupation Unemployed 275 63.5 [58.9, 67.9] 59 64.8 [54.7, 74.1] 0.540 Employee 82 18.9 [15.5, 22.8] 20 22.0 [14.4, 31.3] Merchant 76 17.6 [14.2, 21.3] 12 13.2 [7.4, 21.3] Gravidity Primigravida 180 41.6 [37.0, 46.3] 48 52.7 [42.5, 62.8] 0.104 Multigravida 219 50.6 [45.9, 55.3] 35 38.5 [29.0, 48.7] Grand multigravida 34 7.9 [5.6, 10.7] 8 8.8 [4.2, 15.9] Parity Primipara 187 43.2 [38.6, 47.9] 48 52.7 [42.5, 62.8] 0.174 Multipara 213 49.2 [44.5, 53.9] 35 38.5 [29.0, 48.7] Grand multipara 33 7.6 [5.4, 10.4] 8 8.8 [4.2, 15.9] previous CD Yes 147 33.9 [29.6, 38.5] 20 22.0 [14.4, 31.3] 0.078 No 107 24.7 [20.8, 28.9] 25 27.5 [19.1, 37.2] NA 179 41.3 [36.8, 46.0] 46 50.5 [40.4, 60.7] If yes, CD Number One 124 84.4 [77.8, 89.5] 19 95.0 [78.9, 99.5] 0.203 2 and above 23 15.6 [10.5, 22.2] 1 5.0 [0.5, 21.1] Abortion Yes 30 6.9 [4.8, 9.6] 8 8.8 [4.2, 15.9] 0.533 No 403 93.1 [90.4, 95.2] 83 91.2 [84.1, 95.8] ANC Yes 430 99.3 [98.2, 99.8] 90 98.9 [95.0, 99.9] 0.686 No 3 0.7 [0.2, 1.8] 1 1.1 [0.1, 5.0] GA Determination Unknown 78 18.0 [14.6, 21.8] 19 20.9 [13.5, 30.1] 0.522 Known 355 82.0 [78.2, 85.4] 72 79.1 [69.9, 86.5] Number of fetuses Singleton 410 94.7 [92.3, 96.5] 90 98.9 [95.0, 99.9] 0.081 Twin 23 5.3 [3.5, 7.7] 1 1.1 [0.1, 5.0] 3.2. Current pregnancy and labor characteristics ANC attendance was nearly universal (>99%) in both groups. Nearly half of the CDs were performed at full term. The decision to perform CD was made predominantly by senior residents (86.5% in group one; 98.9% in group two). However, junior residents performed most surgeries in group one (58.2%) compared to only 14.3% in group two CD. In group one, the common indication for CD was a non-reassuring fetal heart rate pattern (33.7%), followed by previous CDs with comorbidities (23.8%). In contrast, cephalopelvic disproportion (CPD) was the leading indication in group two (52.7%). Labor characteristics showed that prolonged rupture of membranes (>12 hours) was more frequent in group two (24.2%) compared to group one (14.5%). Normal fetal heartbeats were more common in group two. Interventions such as induction and augmentation were more commonly performed in group one, whereas instrumental delivery trials were more frequent in group two. (Table 2) Table 2: Intrapartum characteristics of caesarean deliveries according to stage of labor Variable First (N=433) Second (N=91) P value N % [95% CI] N % [95% CI] Stage of labor 1st stage 433 100.0 0 0.0 2nd stage 0 0.0 91 100.0 Duration of ROM Less than 12 hours 370 85.5 [81.9, 88.5] 69 75.8 [66.3, 83.7] 0.024 More than 12 hours 63 14.5 [11.5, 18.1] 22 24.2 [16.3, 33.7] FHB Normal 273 63.0 [58.4, 67.5] 63 69.2 [59.3, 78.0] 0.067 Bradycardia 43 9.9 [7.4, 13.0] 14 15.4 [9.1, 23.8] Tachycardia 114 26.3 [22.3, 30.6] 13 14.3 [8.3, 22.5] Negative 3 0.7 [0.2, 1.8] 1 1.1 [0.1, 5.0] Obstetric complication Yes 92 21.2 [17.6, 25.3] 13 14.3 [8.3, 22.5] 0.132 No 341 78.8 [74.7, 82.4] 78 85.7 [77.5, 91.7] Chronic medical illness Yes 5 1.2 [0.4, 2.5] 1 1.1 [0.1, 5.0] 0.964 No 428 98.8 [97.5, 99.6] 90 98.9 [95.0, 99.9] Intervention Induction 55 12.7 [9.8, 16.1] 3 3.3 [0.9, 8.5] 0.000 Augmentation 16 3.7 [2.2, 5.8] 6 6.6 [2.8, 13.1] ARM 0 0.0 1 1.1 [0.1, 5.0] Trial of instrument 0 0.0 2 2.2 [0.5, 6.9] None 362 83.6 [79.9, 86.9] 79 86.8 [78.7, 92.6] Level of deciding physician Junior resident 15 3.5 [2.0, 5.5] 1 1.1 [0.1, 5.0] 0.233 Senior resident 418 96.5 [94.5, 98.0] 90 98.9 [95.0, 99.9] Level of surgeon Junior resident 252 58.2 [53.5, 62.8] 13 14.3 [8.3, 22.5] 0.000 Senior resident 181 41.8 [37.2, 46.5] 78 85.7 [77.5, 91.7] Indications for Cesarean delivery CPD at first stage of labor 19 4.4 [2.8, 6.6] 0 0.0 0.000 CPD at second stage of labor 0 0.0 48 52.7 [42.5, 62.8] Malpresentation 58 13.4 [10.4, 16.8] 5 5.5 [2.1, 11.6] Cord prolapsed 10 2.3 [1.2, 4.1] 2 2.2 [0.5, 6.9] Failed induction 35 8.1 [5.8, 10.9] 0 0.0 Poor progress of labor with x factor 3 0.7 [0.2, 1.8] 2 2.2 [0.5, 6.9] NRFHRP 146 33.7 [29.4, 38.3] 21 23.1 [15.3, 32.5] Maternal indication 6 1.4 [0.6, 2.8] 0 0.0 Previous CD with X factor 103 23.8 [20.0, 28.0] 10 11.0 [5.8, 18.6] LPFSOL with X factor 30 6.9 [4.8, 9.6] 1 1.1 [0.1, 5.0] 2 CD scar in labor 21 4.9 [3.1, 7.2] 1 1.1 [0.1, 5.0] Others (specify) 2 0.5 [0.1, 1.5] 1 1.1 [0.1, 5.0] 3.3. Operation characteristics Spinal anesthesia transverse skin incision and Kerr’s uterine incision were the most commonly used techniques in both groups. Intraoperative complications were more common in second stage CDs (17.6%) compared to first stage (6.2%), with uterine extension being the most frequent complications in group two (11%). The average duration of surgery was significantly longer in group two (59 minutes) than in group one (47 minutes), with a statistically significant difference (p< 0.001). (Table 3) Table 3: Operation characteristics Variable First (N=433) Second (N=91) N % [95% CI] N % P Mode of anesthesia Epidural 4 0.9 [0.3, 2.2] 1 1.1 [0.1, 5.0] 0.072 Spinal 391 90.3 [87.2, 92.8] 74 81.3 [72.4, 88.3] Spinal converted to GA 1 0.2 [0.0, 1.1] 0 0.0 GA 37 8.5 [6.2, 11.5] 16 17.6 [10.8, 26.4] Skin incision Midline 5 1.2 [0.4, 2.5] 1 1.1 [0.1, 5.0] 0.964 Transverse 428 98.8 [97.5, 99.6] 90 98.9 [95.0, 99.9] Type of uterine incision Kerr incision 432 99.8 [98.9, 100.0] 91 100.0 0.646 Classical 1 0.2 [0.0, 1.1] 0 0.0 Meconium-stained amniotic fluid (thick) Yes 18 4.2 [2.6, 6.4] 6 6.6 [2.8, 13.1] 0.312 No 415 95.8 [93.6, 97.4] 85 93.4 [86.9, 97.2] Mode of extraction Cephalic 377 87.1 [83.7, 90.0] 84 92.3 [85.5, 96.5] 0.000 Breech 55 12.7 [9.8, 16.1] 3 3.3 [0.9, 8.5] Reversed breech 1 0.2 [0.0, 1.1] 4 4.4 [1.5, 10.1] Decision to skin incision Less than 30 minutes 192 44.3 [39.7, 49.0] 43 47.3 [37.2, 57.5] 0.090 30_60 minutes 188 43.4 [38.8, 48.1] 44 48.4 [38.3, 58.5] More than 60 minutes 53 12.2 [9.4, 15.6] 4 4.4 [1.5, 10.1] Skin Incision to delivery time Less than 3 minutes 153 35.3 [30.9, 39.9] 38 41.8 [32.0, 52.0] 0.247 3 and above minutes 280 64.7 [60.1, 69.1] 53 58.2 [48.0, 68.0] 3.4. Intraoperative maternal complications and perinatal outcome Women who underwent second-stage cesarean deliveries experienced intraoperative maternal complications more frequently than those who delivered during the first stage. Uterine extension was significantly higher in the second-stage cesarean, occurring in 11% of cases vs. 1.4% in the first-stage cesarean. Regarding neonatal outcomes, although neonatal mortality was slightly higher in the second-stage group (3.3% vs. 1.1%), this difference was not statistically significant (p = 0.118). However, a significantly greater proportion of neonates had a 1st-minute APGAR score of less than 7 in the second-stage group (19.1%) compared to the first-stage group (5.8%) (p<0.001). At the 5th minute and 10th minute, low APGAR scores were uncommon in both groups. NICU admissions were higher in group two (9%) compared to group one (4.9%), with perinatal asphyxia being the most common reason in both. (Table 4) Table 4: Intra-OP complication maternal complications and Neonatal outcomes Intra-OP complication maternal complications First (N=433) Second (N=91) N % [95% CI] N % P Extension 6 1.4 [0.6, 2.8] 10 11.0 [5.8, 18.6] <0.001 Atony 2 0.5 [0.1, 1.5] 0 0.0 Adhesion 17 3.9 [2.4, 6.1] 3 3.3 [0.9, 8.5] Bladder injury 2 0.5 [0.1, 1.5] 1 1.1 [0.1, 5.0] PPH 0 0.0 1 1.1 [0.1, 5.0] Uterine rupture 0 0.0 1 1.1 [0.1, 5.0] None 406 93.8 [91.2, 95.8] 75 82.4 [73.6, 89.2] Neonatal outcome Outcome Alive 447 98.9 [97.6,99.6] 89 96.7 [91.6, 99.1] 0.118 Dead 5 1.1 [0.4, 2.4] 3 3.3 [0.9, 8.4] Total 452 100.0 92 100.0 1 st minute APGAR Less than 7 26 5.8 [3.9, 8.3] 17 19.1 [12.0, 28.2] 0.000 7 and above 421 94.2 [91.7, 96.1] 72 80.9 [71.8, 88.0] Total 447 100.0 89 100.0 5 th minute APGAR Less than7 8 1.8 [0.8, 3.3] 4 4.5 [1.5, 10.3] 0.115 7 and above 439 98.2 [96.7, 99.2] 85 95.5 [89.7, 98.5] Total 447 100.0 89 100.0 10 th minute APGAR Less than 7 7 1.6 [0.7, 3.0] 1 1.1 [0.1, 5.1] 0.753 7 and above 440 98.4 [97.0, 99.3] 88 98.9 [94.9, 99.9] Total 447 100.0 89 100.0 NICU admission diagnosis PNA 10 45.5 [26.3, 65.7] 7 87.5 [54.6, 98.6] 0.137 Sepsis 1 4.5 [0.5, 19.3] 0 0.0 MAS 2 9.1 [1.9, 26.1] 1 12.5 [1.4, 45.4] Others 9 40.9 [22.5, 61.5] 0 0.0 Total 22 100.0 8 100.0 3.5. Predictors of intraoperative complications Multivariate analysis showed that second-stage CDs were associated with nearly threefold increased odds of complications compared to first-stage cesareans (AOR=3.3; 95%I: 1.6-7.1; P=0.002). Previous CD was also a significant predictor of intraoperative complications of cesarean delivery (AOR = 3.6; 95% CI: 1.5–8.5; p = 0.004). (Table 5) Table 5: Predictors of intraoperative complications COR [95% CI] p AOR [95% CI] p Stage of labor First 1 1 Second 3.2 [1.6, 6.2] 0.001 3.3 [1.6, 7.1] 0.002 Parity Primiparous 1 1 Multiparous 2.9 [1.4, 6] 0.004 1.5 [0.6, 3.9] 0.440 Previous CD Yes 3.7 [1.9, 7] <0.001 3.6 [1.5, 8.5] 0.004 No 1 1 Surgeon Junior resident 1 1 Senior resident 2.9 [1.4, 5.7] 0.003 2.1 [1, 4.3] 0.057 4. DISCUSSION With a cesarean delivery (CD) rate of 21.59% across 4,654 deliveries, this study is comparable to rates found in similar resource-constrained settings ( 15 , 29 ), but it is still higher than the WHO-recommended threshold of 10–15% [17, 30–36]. 82.6% of the CDs were performed during the first stage of labor (group one), and 17.36% during the second stage (group two). Of these, 52.14% took place intrapartum. This distribution is in line with research by Sinha et al. [37], who found that only 8.6% of intrapartum CDs were done in the second stage and 91.4% were done in the first. Similarly, Belay et al. and other studies ( 38 , 39 ) discovered that the first stage accounted for 89.1% of intrapartum CDs. However, Belay's intrapartum CD rate of 39.8% is lower than ours of 52.14t ( 39 ). Disparities in institutional procedures, regional referral trends, and demographic traits could all account for this disparity. Our study was specifically carried out in a post-conflict area, where a greater percentage of intrapartum interventions may be caused by delays in access to care. With mean ages of 27.5 (group one) and 27.6 (group two), the maternal age distribution peaked in both groups between the ages of 25 and 29. These results are consistent with those of Sinha SM et al. ( 40 ) and Govender et al. ( 41 ), who reported mean ages of 24.75 and 25.7 years, respectively. The small discrepancy might be due to demographic variations, such as post-conflict or urbanized populations' later maternal ages at first childbirth. However, the similarity between studies highlights the peak of reproductive age and implies that maternal age is not a significant determinant of the timing of CDs. Regarding obstetric history, group one was more likely to be multigravida (50.6%), whereas group two was more likely to be primigravid (52.7%). Anusha et al. [42] and Sinha et al. [39] have also noted this pattern, identifying even greater proportions of primigravidas in second-stage CDs. This is consistent with the known link between nulliparity and protracted second-stage labor. Because multigravidas were more prevalent in group one, it was not surprising that previous CD history was more prevalent there. This is consistent with previous research and biological plausibility [33–37]. Similar to findings from Anusha et al. [42] and Sinha et al. [40], the majority of CDs were performed at term (39–40 weeks) in both groups. In all of these studies, there was no significant difference in gestational age between groups, suggesting that labor stage at CD is more likely to be associated with labor progression than gestational maturity. Depending on the stage of labor, different CD indications were given. The most prevalent condition in group one was non-reassuring fetal heart rate pattern (NRFHRP) (33.7%), which was followed by prior CD with complications (23.8%). Cephalopelvic disproportion (CPD) was the most common condition in group two (52.7%). Belay et al. [36], who also identified NRFHRP and CPD as leading indicators in the first and second stages, respectively, corroborate these findings. Since mechanical factors like obstructed labor become more noticeable during advanced descent of the fetal head, it is expected that CPD will predominate in second-stage CDs. Variations in induction protocols and access to intrapartum monitoring tools may be the cause of differences in indication patterns across studies, as evidenced by the high rate of failed induction reported by Anusha et al. (942). Second-stage CDs had significantly higher surgical complexity. In line with Sinha et al. [37] and Anusha et al. [42], who also reported noticeably longer durations for second-stage CDs, group two's average operative time was significantly longer (59 minutes) than group one's (47 minutes). Deeply impacted fetal heads, thinning of the lower uterine segment, and increased technical difficulty are probably the causes of this increase. Uterine extension was the most common intraoperative complication in group two (11%) and was much more common in group two (17.6%) than in group one (6.2%). Anusha et al. [42] and Belay et al. [39], who also noted noticeably greater maternal morbidity during second-stage CDs, support this finding. The distended, thinned lower uterine segment and the challenge of delivering an engaged fetal head are probably the causes of uterine extensions in the second stage, which may also raise the risk of hemorrhage and bladder damage. Additionally, the second-stage group had worse neonatal outcomes. Perinatal asphyxia was the most common reason for NICU admissions (9% vs. 4.9%), and first-minute APGAR scores below 7 were significantly more common (19.1% vs. 5.8%, p < 0.001). These results are in line with research by Allen et al. [26] and Sinha et al. [37], which found that fetal head impaction and prolonged labor caused higher NICU admissions and increased perinatal morbidity in second-stage CDs. Despite a marginally higher neonatal mortality rate in group two (3.3% vs. 1.1%), this difference was not statistically significant, possibly because of sample size restrictions. The independent association between CDs performed during the second stage of labor and a threefold increase in intraoperative complications was confirmed by multivariate analysis (AOR = 3.3, 95% CI: 1.6–7.1, p = 0.002). Additionally, a history of previous CD was an independent predictor (AOR = 3.6, 95% CI: 1.5–8.5, p = 0.004). These results highlight the need for increased intraoperative vigilance in such situations and are in line with previous research [32–35, 42]. As one of the first studies from a post-conflict region to examine intrapartum CDs with an emphasis on labor stage and its effects on maternal and neonatal outcomes, the setting adds crucial context: delayed referrals, inadequate infrastructure, and compromised health systems likely affect the timing and complexity of CDs. These contextual factors may account for some of the deviations from expected patterns and emphasize the significance of bolstering obstetric services in post-conflict recovery efforts. 5. LIMITATION OF THE STUDY One notable limitation was the challenge in accurately assessing participants' income and occupational status due to the aftermath of the conflict in the study area, where displacement and unemployment were widespread. This contextual factor may have influenced the socioeconomic variables captured. 6. CONCLUSION This study shows that cesarean deliveries during the first and second stages of labor resulted in notable differences in maternal and neonatal outcomes. Longer procedure durations, higher rates of intraoperative complications, and poor neonatal outcomes were all linked to second-stage cesarean deliveries. The clinical difficulties encountered during this stage of labor were highlighted by the significantly higher prevalence of uterine extension injuries and low APGAR scores in the second stage. 7. RECOMMENDATIONS Early Recognition and Prompt Decision-Making The incidence of second-stage CDs and the complications they cause may be decreased with early detection of labor abnormalities and earlier cesarean delivery decisions. It is important to emphasize the use of partograph monitoring and active labor management procedures. Skilled surgical training To reduce maternal trauma during second-stage procedures, training in advanced cesarean techniques is crucial, particularly for handling deeply impacted fetal heads. In this sense, junior obstetricians benefit greatly from simulation-based training and mentoring. Strengthening Referral Systems Improving transportation networks and referral systems can help prevent prolonged labors that require second-stage CDs in post-conflict and resource-constrained environments by reducing delays in accessing emergency obstetric care. Preoperative Risk Stratification In order to prevent emergency second-stage procedures, women who have had previous cesarean sections or who have risk factors for labor dystocia should be closely monitored and given advice about the possibility of early intervention. Future research In low-resource and post-conflict settings, more prospective research is advised to examine the long-term outcomes for mothers and newborns after second-stage cesarean deliveries. Furthermore, research is necessary to determine how instrumental deliveries contribute to the decrease of second-stage CDs. Declarations Ethics approval and consent to participate : Ethical approval for this study was granted by Mekelle university college of health science ethical board (No. MU-IRB 2063/2023). Written informed consent was obtained from all participants. The study is done in accordance with the Declaration of Helsinki (as revised in 2013) and Good Clinical Practice Guidelines. Consent for publication : Not Applicable. Competing interests : The authors declare no competing interests Funding: This work was supported by the Mekelle university college of health science Author Contribution HGG: conceptualization, data curation, project administration, visualization, writing-original draft, writing-review, and editing. MNG: Data curation, supervision, project administration, writing-reviewing and editing. BKR: Data curation, writing review and editing. GKB: writing review, and editing. THW: writing review, and editing Data Availability Data is provided within the manuscript or supplementary information files References Lyell DJ, Power M, Murtough K, Ness A, Anderson B, Erickson K, et al. surgical techniques at cesarean delivery: a US survey. surg j. 2016;2(04):e119–25. vineshree govender. mp, moodley j. second stage cesarean setion at a teritiary hospital in south africa. J maternal-fetal neonatal Med. 2010;23(10):1151–5. Gedefaw G, Demis A, Alemnew B, Wondmieneh A. A. G. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia : a systematic review and meta-analysis. BMC. 2020:1–10. vineshree govender m mj. second stage cesarean setion at a teritiary hospital in south africa. the journal of maternal-fetal & neonatal medicine. 2010;;23(10):1151-5. Vousden N, Cargill Z, Briley A, Tydeman G. AH. S. Caesarean section at full dilatation: incidence, impact and current management. Obstetrician Gynaecologist 2014 jul 1;16(3):199–205. McKelvey A, Ashe R, McKenna D. Caesarean section in the second stage of labour: a retrospective review of obstetric setting and morbidity. J Obstet Gynaeco. 2010;30(3):264. Unterscheider J, McMenamin M. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynecol Repro Biol. 2011;157(2):141–4. U S. Changes in Primary and Repeat Cesarean Delivery. Vital Stat Rapid Release Rep. 2022(21). Notzon FCCS, Bergsjø P, Cole S, Taffel SIL, Daltveit AK. Cesarean section Delivery in the 1980's: International comparison by indication. Ame J Obstet Gynecol. 1994;170(2):495–504. J. W. Alarming global rise in caesarean births. figures show. 2018;4319(october). Matshidze KP, Richter LM, Ellison GTH, Levin JB, Europe JAM. PMC Funders Group Caesarean Section Rates in South Africa: evidence of bias among different ‘ population groups. ’. 2007;3(0):71–9. Rudey EL. G. R. Cesarean section rates in Brazil.:1–7. Eyi EGY. An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2021;34(16):2682–92. The Landscape of. Cesarean Section in Sub-Saharan Africa and South and Southeast Asia. Bayray A. G. F. Determinants of Caesarean Delivery in Ayder Referral Hospital, Mekelle, Tigray, Ethiopia 2015: A Case Control Study. 2016(may 2017). HMMGHt F, Gary Cunningham MP, Kenneth J, Leveno M, Jodi S, Dashe MP, Professor BL, Hoffman MD, Catherine Y, Spong MP, et al. editors. 2022:1405–10. WHO Statement on. Caesarean Section Rates. 2014. Chawanpaiboon S, Titapant V. Maternal complication of caesarean section at tertiary center: Siriraj Hospital, Bangkok, Thailand. Afr J Reprod Health. 2022;26(augest):142–54. Chawanpaiboon S, Titapant V. Neonatal complication of caesarean sections at tertiary center: Siriraj hospital. Bangkok Thail. 2022;26(september):118–32. Tadevosyan M, Ghazaryan A, Harutyunyan A, Petrosyan VAA. Factors contributing to rapidly increasing rates of cesarean section in Armenia: a partially mixed concurrent quantitative- qualitative equal status study. BMC Pregnancy Childbirth. 2019;6:1–10. Steven G, Gabbe M, Jennifer R, Niebyl M, Joe Leigh Simpson M, Mark B, Landon M, Henry L, Galan M, Eric RM, Jauniaux M, PhD et al. Obstet Normal Problem Pregnancies Sci 2017;7. Moodliar M. Complications following caesarean delivery at King Edward VIII Hospital, Durban, South Africa. Obstet Gynaecol Forum. 2004;14:21–6. DiMatteo MR, Morton SC, Lepper HS, Damush TM, Carney MF, Pearson M, et al. Cesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychol NHS Centre Rev Dissemin. 1996;15:303–14. Nielson TF. C/S and intra-operative surgical complications. Acta Obstet Gynecol Scand. 1984;63:103–8. Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong GS, et al. Comparison of maternal and infant outcomes from primary caesarean delivery during the second compared with first stage of labour. Obstet Gynecol. 2007;109:917–21. Allen VM, O’Connell CM. Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. Br J Obstet Gynaecol. 2005;112:986–90. Altman MR. L-R. Prolonged second stage of labour and risk of adverse maternal and perinatal outcomes: a systematic review. Birth. 2006;33:4. Cebekulu L. Complications associated with C/ S in the second stage of labour. Int J Gynaecol Obstet. 2006;95:110–4. Dumont A, De Bernis L, Bouvier-olle MH, Bréart G. Group. MS. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet. 2001;358(9290):1328–33. Murray SF. FS. P. Health sector reform and rise of caesarean with in Chile. Lancet. 1997;349(9044):34. Pai M, Sundaram P, Radhakrishnan KK, Thomas K. JP. M. A high rate of Caesarean sections in an affluent section of Chennai.is it cause for concern? Natl Med J India. 1999;12(4):156–8. Anusha SR, Deepak AV*, Jacob KJ. Maternal and neonatal outcome in second stage cesarean section versus first stage: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4640–5. Betran AP, Ye J, Moller B. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Heal. 2021;6:1–8. R. A. Trend And Associated Factors Of Cesarean Section Rate In Ethiopia: Evidence From 2000–2019 Demographic And Health Survey. Res Artic. 2022:1–22. Prachi Dahiya S, Agarwal, Najam R. Retrospective Analysis of Second Stage of Cesarean Section and Pregnancy Outcomes: An Observational Study. J South Asian Federation Obstet Gynecol. 2022;14(1). terefayehu belay. lukman yusuf, negash s. a comparative study on first stage versus second stage cesarean section on maternal and perinatal outcome. Ethiop Med J. 2014;52(1):1–8. Sushma Sinha S, Malik, Dixit M. First versus second stage caesarean section: a comparison of maternal and neonatal outcomes. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3477–80. Goswami DK, Parmar MM, Kunjadiya AN. Study of fetomaternal outcome in second stage caesarean section. Int J Reprod Contracept Obstet Gynecol. 2019 jun;8(6):2169–71. terefayehu belay ly. negash s. a comparative study on first stage versus second stage cesarean section on maternal and perinatal outcome. Ethiop Med J. 2014;52(1):1–8. Sushma Sinha SM, Dixit M. First versus second stage caesarean section: a comparison of maternal and neonatal outcomes. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3477–80. vineshree govender m. moodley j. second stage cesarean setion at a teritiary hospital in south africa. J maternal-fetal neonatal Med. 2010;23(10):1151–5. Anusha SR, DAV, Jacob KJ. Maternal and neonatal outcome in second stage cesarean section versus first stage: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4640–5. Additional Declarations No competing interests reported. Supplementary Files Questionnaire.docx spssexcell.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 11 Aug, 2025 Editor assigned by journal 06 Aug, 2025 Editor invited by journal 14 Jul, 2025 Submission checks completed at journal 11 Jul, 2025 First submitted to journal 11 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6957859","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501221985,"identity":"56ec0e37-9579-4cba-98e4-e35810fd04dd","order_by":0,"name":"Haftom Guesh Girmay","email":"","orcid":"","institution":"Aksum university college of health science","correspondingAuthor":false,"prefix":"","firstName":"Haftom","middleName":"Guesh","lastName":"Girmay","suffix":""},{"id":501221986,"identity":"a11da5bf-44bc-4969-b351-de20b2aa126f","order_by":1,"name":"Musie Negasi 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medicine","correspondingAuthor":false,"prefix":"","firstName":"Birhanu","middleName":"Kassie","lastName":"Reta","suffix":""},{"id":501221988,"identity":"2edc67bd-4a93-456d-b880-2d52bfc5e215","order_by":3,"name":"Goytoom Kahsay Berhe","email":"","orcid":"","institution":"Mekelle university college of health science, school of medicine","correspondingAuthor":false,"prefix":"","firstName":"Goytoom","middleName":"Kahsay","lastName":"Berhe","suffix":""},{"id":501221989,"identity":"0adde2e3-d74a-4764-a8ef-11f124c0b6e1","order_by":4,"name":"Tsion Haile Woldemariam","email":"","orcid":"","institution":"Arba Minch university college of health science, school of medicine","correspondingAuthor":false,"prefix":"","firstName":"Tsion","middleName":"Haile","lastName":"Woldemariam","suffix":""}],"badges":[],"createdAt":"2025-06-23 14:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6957859/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6957859/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89401856,"identity":"2c37c1a3-6b1c-45cf-8f10-b315fffb042b","added_by":"auto","created_at":"2025-08-19 14:24:13","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":183705,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003econceptual frame work\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6957859/v1/0499208ec7c5d66629a23d9c.jpeg"},{"id":89403420,"identity":"1978ba1e-3dad-4cac-a702-953e4f01e3df","added_by":"auto","created_at":"2025-08-19 14:40:13","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":173504,"visible":true,"origin":"","legend":"\u003cp\u003eflow chart of mothers selected from this study\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6957859/v1/feba98800f5672344fde6d1e.jpeg"},{"id":89403708,"identity":"efd20a90-dd2f-46d9-8503-5e3e02beba90","added_by":"auto","created_at":"2025-08-19 14:48:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1586937,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6957859/v1/ca0939c0-ac15-4c2d-a903-9d65d5a28253.pdf"},{"id":89401855,"identity":"1a099737-a6bf-46ef-8373-861152733617","added_by":"auto","created_at":"2025-08-19 14:24:13","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21149,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-6957859/v1/f7fa5c872b10466277740145.docx"},{"id":89401857,"identity":"0ccee38e-1c28-4e11-b56c-975b44e17ec7","added_by":"auto","created_at":"2025-08-19 14:24:13","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":149036,"visible":true,"origin":"","legend":"","description":"","filename":"spssexcell.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6957859/v1/090d51964435c78dd3a885b2.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eThe most common major abdominal surgery performed on women worldwide is cesarean delivery (CD) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). When medically indicated, it can save the mother's and the fetus's lives, but its rising prevalence has raised concerns, especially in low- and middle-income countries (LMICs), where resources are frequently (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). CD rates have increased dramatically over the last few decades in both high-income and resource-constrained environments, including Ethiopia. Rates have surpassed 50% in certain middle-income nations, and pooled estimates place Ethiopia's national CD rate at about5% (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCompared to first-stage or elective CDs, cesarean deliveries that occur during the second stage of labor, when full cervical dilatation has been reached, present particular difficulties and are linked to increased maternal and neonatal mortality (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Because of the deeply engaged fetal head, higher risk of bleeding, damage to nearby pelvic structures, longer operating times, and more frequent postoperative complications, second-stage CDs are technically more (\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Additionally, there is an increased risk of birth asphyxia, low APGAR scores, and admission to the neonatal intensive care unit (NICU) for babies delivered via second-stage D (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to recent studies, there is a global trend toward an increase in second stages (\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25 CR26 CR27\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This trend is ascribed to a number of factors, including a lack of training in operative vaginal deliveries, heightened medicolegal concerns, and delayed labor decision-making (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Similar to worldwide patterns, a sizable percentage of CDs are performed during labor (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Nevertheless, there is still a dearth of local data and context-specific management guidelines for second-stage CDs, despite their increasing prevalence and clinical significance. (Fig.\u0026nbsp;1)\u003c/p\u003e\u003cp\u003eBy comparing the maternal and neonatal outcomes of first-stage versus second-stage cesarean deliveries in public hospitals in Mekelle, Ethiopia, this study seeks to close this disparity. In order to improve results, the findings are meant to support appropriate counseling of mothers and families, improve provider training, guide clinical decision-making, and aid in the creation of regional referral and protocol systems. \u003cem\u003eFigure 1: conceptual frame work\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"2. METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study area and Period\u003c/h2\u003e\u003cp\u003eThis study was conducted at Ayder Comprehensive Specialized Hospital (ACSH) and Mekelle General Hospital (MGH), both located in Mekelle, Northern Ethiopia. ACSH is the largest tertiary public hospital in the country, serving a catchment population exceeding 8\u0026nbsp;million people across the Tigray, Afar, and northern Amhara regions. The hospital provides a wide range of healthcare services, including specialized obstetric and gynecologic care, and is equipped with 78 inpatient beds, four delivery couches, two emergency rooms, one procedure room, a meeting hall, and dedicated operating and recovery rooms. MGH, affiliated with ACSH, functions as a teaching hospital, primarily for obstetrics and gynecology residents and senior physicians from ACSH. The study was carried out over a period of five months from February 1, 2023 to June 30, 2023\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Study Design and Population\u003c/h2\u003e\u003cp\u003eA facility-based cross-sectional prospective study design was employed. The source of population consisted of all laboring mothers who delivered at either ACSH or MGH during the study period. The study population included all laboring mothers who underwent cesarean delivery at the two hospitals. Among them, women who met the eligibility criteria\u0026mdash;those who underwent cesarean delivery during labor and provided informed consent\u0026mdash;were included as study subjects.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Eligibility criteria\u003c/h2\u003e\u003cp\u003eThe inclusion criteria covered all mothers who underwent cesarean delivery during labor in either hospital within the study timeframe. Mothers with a pre-diagnosed case of uterine rupture were excluded from the study to ensure uniformity in clinical conditions evaluated.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Sampling procedure\u003c/h2\u003e\u003cp\u003eA total population sampling approach was used, whereby all women who underwent intrapartum cesarean delivery during the study period were included, ensuring comprehensive data collection.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Study variables\u003c/h2\u003e\u003cp\u003eThe primary dependent variables were adverse maternal and neonatal outcomes. Independent variables included maternal age, residence (urban or educational status, occupation, marital status, antenatal care (ANC) attendance, parity, previous mode of delivery, stage of labor at the time of cesarean, indications for cesarean, decision-maker (status of professional), the surgeon who performed the operation, and fetal condition at the time of decision.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Data Collection Process\u003c/h2\u003e\u003cp\u003eEligible laboring mothers were identified in the labor and delivery wards of both hospitals. Upon obtaining informed consent, trained residents and interns collected data through structured interviews and medical chart reviews. Data were gathered using a combination of patient interviews and review of clinical records to ensure accuracy and completeness. (\u003cb\u003eQuestionnaire uploaded as a supplementary file\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.7. Data Processing and Analysis\u003c/h2\u003e\u003cp\u003eData collected were first reviewed by the principal investigator (PI) for completeness and consistency. Subsequently entered into EpiData software and exported into SPSS for statistical analysis. Both descriptive and inferential statistics were used, with results presented in frequency tables and figures. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.8. Data Quality Assurance\u003c/h2\u003e\u003cp\u003eTo ensure data quality, a pretest involving 5% of the study population was conducted. All data collectors received training on proper data collection techniques and ethical considerations. The PI closely supervised the data collection process to ensure adherence to protocol and timely documentation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.9. Operational Definitions\u003c/h2\u003e\u003cp\u003eSeveral key operational definitions were utilized in this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003e\u0026ldquo;Residents\u003c/b\u003e referred to physicians in specialty training, with \u0026ldquo;\u003cb\u003ejunior residents\u003c/b\u003e\u0026rdquo; being in their first two years and \u0026ldquo;senior residents\u0026rdquo; in their final two years of the program. \u0026rdquo;\u003cb\u003eSeniors\u003c/b\u003e\u0026rdquo; were fully trained specialists.\u003c/p\u003e\u003cp\u003eAn \u003cb\u003eemergency cesarean delivery\u003c/b\u003e\u0026rdquo; was defined as a cesarean performed while the mother was in labor, and a \u0026ldquo;\u003cb\u003esecond-stage cesarean delivery\u003c/b\u003e \u0026ldquo;referred to procedures carried out after full cervical dilation. \u0026rdquo;\u003cb\u003ePrimigravida\u003c/b\u003e \u0026ldquo;referred to a woman giving birth for the first time, while \u0026ldquo;\u003cb\u003emultigravida\u003c/b\u003e \u0026ldquo;included women who had given birth more than once.\u003c/p\u003e\u003cp\u003eA \u003cb\u003eprolonged second stage\u003c/b\u003e\u0026rdquo; was defined as more than 2 hours in primigravida and more than 1 hour in multigravida.\u0026rsquo; \u003cb\u003eMaternal complications\u003c/b\u003e\u0026rdquo; included any adverse outcomes up to 10 days postpartum, and \u0026ldquo;\u003cb\u003eneonatal complications\u003c/b\u003e \u0026ldquo;included any adverse events occurring within 7 days of birth. The \u0026ldquo;\u003cb\u003elast normal menstrual period (LNMP)\u003c/b\u003e\u0026rdquo; and \u0026ldquo;\u003cb\u003eearly ultrasound\u003c/b\u003e \u0026ldquo;(performed before 24 weeks of gestation) were also noted for gestational age assessment. Classification of residence as urban or rural was based on regional government criteria.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.10. Ethical Consideration\u003c/h2\u003e\u003cp\u003e Ethical clearance for the study was granted by the institutional review board of Mekelle University, College of Health Science, with ethical approval number of MU-IRB 2063/2023. To ensure confidentiality, no personal identifiers were collected and were anonymized. Data were stored securely in locked cabinets and password-protected files. Participation in the study was voluntary, and informed consent was obtained from all participants.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULT","content":"\u003cp\u003eOverview of deliveries and study group classification\u003c/p\u003e\n\u003cp\u003eOut of 4,654 total deliveries recorded during the study period ,1005 (21.59%) were cesarean deliveries (CDs). Among these ,524 (52.14%) were conducted during labor. Of the intrapartum CDs, 433 (82.6 %) occurred during the first stage of labor (Group one), while 91 (17.36%) were conducted during second stage of labor (Group two). (Figure 2)\u003c/p\u003e\n\u003cp id=\"_Toc145471422\"\u003e3.1. \u0026nbsp;Socio-demographic characteristics and obstetric history\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of mothers in both groups were aged 25-29 years (38.6 % in group one and 40.7% in group two). The mean age of mothers in group one was 27.5 years with a standard deviation of 5.2, and in group two, the mean ages were 27.5 \u0026plusmn; 5.2 and 27.6 \u0026plusmn; 5 years, respectively. Most mothers were urban residents (85.5% in group one and 79.1 % in group two), and all of the mothers were from Tigray except 1, who is from Afar. Nearly all participants were married and Christian, with a small percentage being single or divorced. A substantial proportion of mothers were referred from other institutions, particularly in group two (60.4% vs. 44.3% in group one). Literacy rates exceeded 94% in both groups, and unemployment was common (63.5%d 63.5%, respectively).\u003c/p\u003e\n\u003cp\u003eGroup one had a higher proportion of multigravida (50.6 %), while Group two had more primigravidas (52.7%). A third of mothers in group one had CD previously compared to 22% in group two, largely because the latter were more likely to be primigravida. Rates of previous abortion were similar between groups (6.9% vs. 8.8%). (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc145479642\"\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: socio-demographic characteristics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and Obstetric history\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"726\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 263px;\"\u003eMaternal characteristics\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 187px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;First (N=433)\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Second (N=91)\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003eP value\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003eN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e% [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003eN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e% [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 119px;\"\u003eAge category\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026lt;20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e4.6 [2.9,6.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e5.5 [2.1,11.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 70px;\"\u003e0.563\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e20-24\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e114\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e26.3 [22.4,30.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e20.9 [13.5,30.1]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e25-29\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e167\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e38.6 [34.1,43.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e37\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e40.7 [31.0,50.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e30-34\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e71\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e16.4 [13.1,20.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e22.0 [14.4,31.3]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026ge;35\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e61\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e14.1 [11.1,17.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e11.0 [5.8,18.6]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eAddress\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eRural \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e14.5 [11.5, 18.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e20.9 [13.5, 30.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.131\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eUrban\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e370\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e85.5 [81.9, 88.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e79.1 [69.9, 86.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eReligion\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eChristian\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e416\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e96.1 [93.9, 97.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e91\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.55\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eMuslim\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e3.9 [2.4, 6.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 119px;\"\u003eMarital status\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eSingle\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e4.6 [2.9, 6.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e7.7 [3.5, 14.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 70px;\"\u003e0.56\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eMarried\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e410\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e94.7 [92.3, 96.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e84\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e92.3 [85.5, 96.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eDivorced\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.5 [0.1, 1.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eWidowed\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.2 [0.0, 1.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 119px;\"\u003eReferral\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eSelf-referred\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e87\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e20.1 [16.5, 24.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e20.9 [13.5, 30.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 70px;\"\u003e0.005\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eReferred\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e192\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e44.3 [39.7, 49.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e55\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e60.4 [50.2, 70.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eHad follow up\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e154\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e35.6 [31.2, 40.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e18.7 [11.7, 27.6]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eEducational status\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eIlliterate\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e24\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e5.5 [3.7, 8.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e4.4 [1.5, 10.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.658\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eLiterate\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e409\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e94.5 [92.0, 96.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e87\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e95.6 [89.9, 98.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 119px;\"\u003eOccupation\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eUnemployed\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e275\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e63.5 [58.9, 67.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e59\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e64.8 [54.7, 74.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 70px;\"\u003e0.540\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eEmployee\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e82\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e18.9 [15.5, 22.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e22.0 [14.4, 31.3]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eMerchant\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e76\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e17.6 [14.2, 21.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e13.2 [7.4, 21.3]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 119px;\"\u003eGravidity\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003ePrimigravida\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e180\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e41.6 [37.0, 46.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e52.7 [42.5, 62.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 70px;\"\u003e0.104\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eMultigravida\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e219\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e50.6 [45.9, 55.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e35\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e38.5 [29.0, 48.7]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eGrand multigravida\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e34\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e7.9 [5.6, 10.7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e8.8 [4.2, 15.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 119px;\"\u003eParity\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003ePrimipara\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e187\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e43.2 [38.6, 47.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e52.7 [42.5, 62.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 70px;\"\u003e0.174\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eMultipara\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e213\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e49.2 [44.5, 53.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e35\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e38.5 [29.0, 48.7]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eGrand multipara\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e33\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e7.6 [5.4, 10.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e8.8 [4.2, 15.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 119px;\"\u003eprevious CD\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e147\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e33.9 [29.6, 38.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e22.0 [14.4, 31.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 70px;\"\u003e0.078\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e107\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e24.7 [20.8, 28.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e25\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e27.5 [19.1, 37.2]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e179\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e41.3 [36.8, 46.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e46\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e50.5 [40.4, 60.7]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eIf yes, CD\u0026nbsp;\u003cbr\u003eNumber\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eOne\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e124\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e84.4 [77.8, 89.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e95.0 [78.9, 99.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.203\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e2 and above\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e23\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e15.6 [10.5, 22.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e5.0 [0.5, 21.1]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eAbortion\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e30\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e6.9 [4.8, 9.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e8.8 [4.2, 15.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.533\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e403\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e93.1 [90.4, 95.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e83\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e91.2 [84.1, 95.8]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eANC\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e430\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e99.3 [98.2, 99.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e98.9 [95.0, 99.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.686\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.7 [0.2, 1.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eGA Determination\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eUnknown\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e78\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e18.0 [14.6, 21.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e20.9 [13.5, 30.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.522\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eKnown\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e355\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e82.0 [78.2, 85.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e79.1 [69.9, 86.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003eNumber of fetuses\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eSingleton\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e410\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e94.7 [92.3, 96.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e98.9 [95.0, 99.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e0.081\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eTwin\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e23\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e5.3 [3.5, 7.7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc145471424\"\u003e\u003cstrong\u003e3.2. \u0026nbsp; \u0026nbsp;Current pregnancy\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and labor characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eANC attendance was nearly universal (\u0026gt;99%) in both groups. Nearly half of the CDs were performed at full term. The decision to perform CD was made predominantly by senior residents (86.5% in group one; 98.9% in group two). However, junior residents performed most surgeries in group one (58.2%) compared to only 14.3% in group two CD.\u003c/p\u003e\n\u003cp\u003eIn group one, the common indication for CD was a non-reassuring fetal heart rate pattern (33.7%), followed by previous CDs with comorbidities (23.8%). In contrast, cephalopelvic disproportion (CPD) was the leading indication in group two (52.7%).\u003c/p\u003e\n\u003cp\u003eLabor characteristics showed that prolonged rupture of membranes (\u0026gt;12 hours) was more frequent in group two (24.2%) compared to group one (14.5%). Normal fetal heartbeats were more common in group two. Interventions such as induction and augmentation were more commonly performed in group one, whereas instrumental delivery trials were more frequent in group two. (Table 2)\u003c/p\u003e\n\u003cp id=\"_Toc145479646\"\u003eTable 2: Intrapartum characteristics of caesarean deliveries according to stage of labor\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"761\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\u0026nbsp;\u003cbr\u003eVariable\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 191px;\"\u003eFirst (N=433)\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 226px;\"\u003eSecond (N=91)\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003eP value\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003eN\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e% [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003eN\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e% [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003eStage of labor\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e1st stage\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e433\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e2nd stage\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e91\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003eDuration of ROM\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eLess than 12 hours\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e370\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e85.5 [81.9, 88.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e69\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e75.8 [66.3, 83.7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e0.024\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eMore than 12 hours\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e14.5 [11.5, 18.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e22\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e24.2 [16.3, 33.7]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 109px;\"\u003eFHB\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNormal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e273\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e63.0 [58.4, 67.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e69.2 [59.3, 78.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 90px;\"\u003e0.067\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eBradycardia\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e43\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e9.9 [7.4, 13.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e14\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e15.4 [9.1, 23.8]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eTachycardia\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e114\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e26.3 [22.3, 30.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e13\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e14.3 [8.3, 22.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNegative\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.7 [0.2, 1.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003eObstetric complication\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e92\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e21.2 [17.6, 25.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e13\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e14.3 [8.3, 22.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e0.132\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e341\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e78.8 [74.7, 82.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e78\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e85.7 [77.5, 91.7]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003eChronic medical illness\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.2 [0.4, 2.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e0.964\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e428\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e98.8 [97.5, 99.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e98.9 [95.0, 99.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 109px;\"\u003eIntervention\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eInduction\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e55\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e12.7 [9.8, 16.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e3.3 [0.9, 8.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 90px;\"\u003e0.000\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eAugmentation\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e16\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e3.7 [2.2, 5.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e6.6 [2.8, 13.1]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eARM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eTrial of instrument\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e2.2 [0.5, 6.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eNone\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e362\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e83.6 [79.9, 86.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e79\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e86.8 [78.7, 92.6]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003eLevel of deciding physician\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eJunior resident\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e15\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e3.5 [2.0, 5.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e0.233\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eSenior resident\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e418\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e96.5 [94.5, 98.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e98.9 [95.0, 99.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003eLevel of surgeon\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eJunior resident\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e252\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e58.2 [53.5, 62.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e13\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e14.3 [8.3, 22.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e0.000\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003eSenior resident\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e181\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e41.8 [37.2, 46.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e78\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e85.7 [77.5, 91.7]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 761px;\"\u003eIndications for Cesarean delivery\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eCPD at first stage of labor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e4.4 [2.8, 6.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e0.000\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eCPD at second stage of labor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e52.7 [42.5, 62.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eMalpresentation\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e58\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e13.4 [10.4, 16.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e5.5 [2.1, 11.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eCord prolapsed\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e2.3 [1.2, 4.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e2.2 [0.5, 6.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eFailed induction\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e35\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e8.1 [5.8, 10.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003ePoor progress of labor with x factor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.7 [0.2, 1.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e2.2 [0.5, 6.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eNRFHRP\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e146\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e33.7 [29.4, 38.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e21\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e23.1 [15.3, 32.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eMaternal indication\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.4 [0.6, 2.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003ePrevious CD with X factor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e103\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e23.8 [20.0, 28.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e11.0 [5.8, 18.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eLPFSOL with X factor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e30\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e6.9 [4.8, 9.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e2 CD scar in labor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e21\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e4.9 [3.1, 7.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003eOthers (specify)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e0.5 [0.1, 1.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc145471426\"\u003e\u003cstrong\u003e3.3. \u0026nbsp; \u0026nbsp;Operation characteristics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpinal anesthesia transverse skin incision and Kerr\u0026rsquo;s uterine incision were the most commonly used techniques in both groups. Intraoperative complications were more common in second stage CDs (17.6%) compared to first stage (6.2%), with uterine extension being the most frequent complications in group two (11%).\u003c/p\u003e\n\u003cp\u003eThe average duration of surgery was significantly longer in group two (59 minutes) than in group one (47 minutes), with a statistically significant difference (p\u0026lt; 0.001). (Table 3)\u003c/p\u003e\n\u003cp id=\"_Toc145479647\"\u003eTable 3: Operation characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"109%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 35px;\"\u003e\u0026nbsp;\u003cbr\u003eVariable\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003eFirst (N=433)\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 25px;\"\u003eSecond (N=91)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003eN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e% [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003eN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003eP\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 18px;\"\u003eMode of anesthesia\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eEpidural\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e0.9 [0.3, 2.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 8px;\"\u003e0.072\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eSpinal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e391\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e90.3 [87.2, 92.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e74\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e81.3 [72.4, 88.3]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eSpinal converted to GA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e0.2 [0.0, 1.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eGA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e37\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e8.5 [6.2, 11.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e16\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e17.6 [10.8, 26.4]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003eSkin incision\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eMidline\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e1.2 [0.4, 2.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e0.964\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eTransverse\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e428\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e98.8 [97.5, 99.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e98.9 [95.0, 99.9]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003eType of uterine incision\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eKerr incision\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e432\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e99.8 [98.9, 100.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e91\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e0.646\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eClassical\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e0.2 [0.0, 1.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003eMeconium-stained amniotic fluid (thick)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e4.2 [2.6, 6.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e6.6 [2.8, 13.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e0.312\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e415\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e95.8 [93.6, 97.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e85\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e93.4 [86.9, 97.2]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003eMode of extraction\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eCephalic\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e377\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e87.1 [83.7, 90.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e84\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e92.3 [85.5, 96.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e0.000\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eBreech\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e55\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e12.7 [9.8, 16.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e3.3 [0.9, 8.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eReversed breech\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e0.2 [0.0, 1.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e4.4 [1.5, 10.1]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003eDecision to skin incision\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eLess than 30 minutes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e192\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e44.3 [39.7, 49.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e43\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e47.3 [37.2, 57.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e0.090\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e30_60 minutes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e188\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e43.4 [38.8, 48.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e44\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e48.4 [38.3, 58.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eMore than 60 minutes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e12.2 [9.4, 15.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e4.4 [1.5, 10.1]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003eSkin Incision to delivery time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003eLess than 3 minutes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e153\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e35.3 [30.9, 39.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e38\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e41.8 [32.0, 52.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e0.247\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e3 and above minutes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e280\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e64.7 [60.1, 69.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e58.2 [48.0, 68.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.4. \u0026nbsp; \u0026nbsp;Intraoperative maternal complications and perinatal outcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc145479649\"\u003eWomen who underwent second-stage cesarean deliveries experienced intraoperative maternal complications more frequently than those who delivered during the first stage. Uterine extension was significantly higher in the second-stage cesarean, occurring in 11% of cases vs. 1.4% in the first-stage cesarean. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding neonatal outcomes, although neonatal mortality was slightly higher in the second-stage group (3.3% vs. 1.1%), this difference was not statistically significant (p = 0.118). However, a significantly greater proportion of neonates had a 1st-minute APGAR score of less than 7 in the second-stage group (19.1%) compared to the first-stage group (5.8%) (p\u0026lt;0.001). At the 5th minute and 10th minute, low APGAR scores were uncommon in both groups. NICU admissions were higher in group two (9%) compared to group one (4.9%), with perinatal asphyxia being the most common reason in both. (Table 4)\u003c/p\u003e\n\u003cp\u003eTable 4: Intra-OP complication maternal complications and Neonatal outcomes\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 19px;\"\u003eIntra-OP complication maternal complications\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 27px;\"\u003eFirst (N=433)\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 23px;\"\u003eSecond (N=91)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003eN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e% [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003eN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003eP\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eExtension\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e1.4 [0.6, 2.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e11.0 [5.8, 18.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 10px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eAtony\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e0.5 [0.1, 1.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eAdhesion\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e3.9 [2.4, 6.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e3.3 [0.9, 8.5]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eBladder injury\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e0.5 [0.1, 1.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003ePPH\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eUterine rupture\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e1.1 [0.1, 5.0]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eNone\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e406\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e93.8 [91.2, 95.8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e75\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e82.4 [73.6, 89.2]\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 100px;\"\u003eNeonatal outcome\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 19px;\"\u003eOutcome\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eAlive\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e447\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e98.9 [97.6,99.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e89\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e96.7 [91.6, 99.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e0.118\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eDead\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e1.1 [0.4, 2.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e3.3 [0.9, 8.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e452\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e92\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 19px;\"\u003e1\u003csup\u003est\u003c/sup\u003e minute APGAR\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eLess than 7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e26\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e5.8 [3.9, 8.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e19.1 [12.0, 28.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e0.000\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e7 and above\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e421\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e94.2 [91.7, 96.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e80.9 [71.8, 88.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e447\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e89\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 19px;\"\u003e5\u003csup\u003eth\u003c/sup\u003e minute APGAR\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eLess than7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e1.8 [0.8, 3.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e4.5 [1.5, 10.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e0.115\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e7 and above\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e439\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e98.2 [96.7, 99.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e85\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e95.5 [89.7, 98.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e447\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e89\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 19px;\"\u003e10\u003csup\u003eth\u003c/sup\u003e minute APGAR\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eLess than 7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e1.6 [0.7, 3.0]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e1.1 [0.1, 5.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e0.753\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e7 and above\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e440\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e98.4 [97.0, 99.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e88\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e98.9 [94.9, 99.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e447\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e89\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 19px;\"\u003eNICU admission diagnosis\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003ePNA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e45.5 [26.3, 65.7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e87.5 [54.6, 98.6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e0.137\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eSepsis\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e4.5 [0.5, 19.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eMAS\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e9.1 [1.9, 26.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e12.5 [1.4, 45.4]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eOthers\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e40.9 [22.5, 61.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e0.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e22\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e100.0\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.5. \u0026nbsp; \u0026nbsp;Predictors of intraoperative complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariate analysis showed that second-stage CDs were associated with nearly threefold increased odds of complications compared to first-stage cesareans (AOR=3.3; 95%I: 1.6-7.1; P=0.002). Previous CD was also a significant predictor of intraoperative complications of cesarean delivery (AOR = 3.6; 95% CI: 1.5\u0026ndash;8.5; \u003cem\u003ep\u003c/em\u003e = 0.004).\u0026nbsp;(Table 5)\u003c/p\u003e\n\u003cp\u003eTable 5: Predictors of intraoperative complications\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003eCOR [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003ep\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003eAOR [95% CI]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003ep\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003eStage of labor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eFirst\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eSecond\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e3.2 [1.6, 6.2]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e0.001\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e3.3 [1.6, 7.1]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e0.002\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003eParity\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003ePrimiparous\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eMultiparous\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e2.9 [1.4, 6]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e0.004\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e1.5 [0.6, 3.9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e0.440\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003ePrevious CD\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e3.7 [1.9, 7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e3.6 [1.5, 8.5]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e0.004\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003eSurgeon\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eJunior resident\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003eSenior resident\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e2.9 [1.4, 5.7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e0.003\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e2.1 [1, 4.3]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e0.057\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eWith a cesarean delivery (CD) rate of 21.59% across 4,654 deliveries, this study is comparable to rates found in similar resource-constrained settings (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), but it is still higher than the WHO-recommended threshold of 10\u0026ndash;15% [17, 30\u0026ndash;36]. 82.6% of the CDs were performed during the first stage of labor (group one), and 17.36% during the second stage (group two). Of these, 52.14% took place intrapartum. This distribution is in line with research by Sinha et al. [37], who found that only 8.6% of intrapartum CDs were done in the second stage and 91.4% were done in the first. Similarly, Belay et al. and other studies (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) discovered that the first stage accounted for 89.1% of intrapartum CDs. However, Belay's intrapartum CD rate of 39.8% is lower than ours of 52.14t (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Disparities in institutional procedures, regional referral trends, and demographic traits could all account for this disparity. Our study was specifically carried out in a post-conflict area, where a greater percentage of intrapartum interventions may be caused by delays in access to care.\u003c/p\u003e\u003cp\u003eWith mean ages of 27.5 (group one) and 27.6 (group two), the maternal age distribution peaked in both groups between the ages of 25 and 29. These results are consistent with those of Sinha SM et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and Govender et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), who reported mean ages of 24.75 and 25.7 years, respectively. The small discrepancy might be due to demographic variations, such as post-conflict or urbanized populations' later maternal ages at first childbirth. However, the similarity between studies highlights the peak of reproductive age and implies that maternal age is not a significant determinant of the timing of CDs.\u003c/p\u003e\u003cp\u003eRegarding obstetric history, group one was more likely to be multigravida (50.6%), whereas group two was more likely to be primigravid (52.7%). Anusha et al. [42] and Sinha et al. [39] have also noted this pattern, identifying even greater proportions of primigravidas in second-stage CDs. This is consistent with the known link between nulliparity and protracted second-stage labor. Because multigravidas were more prevalent in group one, it was not surprising that previous CD history was more prevalent there. This is consistent with previous research and biological plausibility [33\u0026ndash;37].\u003c/p\u003e\u003cp\u003eSimilar to findings from Anusha et al. [42] and Sinha et al. [40], the majority of CDs were performed at term (39\u0026ndash;40 weeks) in both groups. In all of these studies, there was no significant difference in gestational age between groups, suggesting that labor stage at CD is more likely to be associated with labor progression than gestational maturity.\u003c/p\u003e\u003cp\u003eDepending on the stage of labor, different CD indications were given. The most prevalent condition in group one was non-reassuring fetal heart rate pattern (NRFHRP) (33.7%), which was followed by prior CD with complications (23.8%). Cephalopelvic disproportion (CPD) was the most common condition in group two (52.7%). Belay et al. [36], who also identified NRFHRP and CPD as leading indicators in the first and second stages, respectively, corroborate these findings. Since mechanical factors like obstructed labor become more noticeable during advanced descent of the fetal head, it is expected that CPD will predominate in second-stage CDs. Variations in induction protocols and access to intrapartum monitoring tools may be the cause of differences in indication patterns across studies, as evidenced by the high rate of failed induction reported by Anusha et al. (942).\u003c/p\u003e\u003cp\u003eSecond-stage CDs had significantly higher surgical complexity. In line with Sinha et al. [37] and Anusha et al. [42], who also reported noticeably longer durations for second-stage CDs, group two's average operative time was significantly longer (59 minutes) than group one's (47 minutes). Deeply impacted fetal heads, thinning of the lower uterine segment, and increased technical difficulty are probably the causes of this increase.\u003c/p\u003e\u003cp\u003eUterine extension was the most common intraoperative complication in group two (11%) and was much more common in group two (17.6%) than in group one (6.2%). Anusha et al. [42] and Belay et al. [39], who also noted noticeably greater maternal morbidity during second-stage CDs, support this finding. The distended, thinned lower uterine segment and the challenge of delivering an engaged fetal head are probably the causes of uterine extensions in the second stage, which may also raise the risk of hemorrhage and bladder damage.\u003c/p\u003e\u003cp\u003eAdditionally, the second-stage group had worse neonatal outcomes. Perinatal asphyxia was the most common reason for NICU admissions (9% vs. 4.9%), and first-minute APGAR scores below 7 were significantly more common (19.1% vs. 5.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results are in line with research by Allen et al. [26] and Sinha et al. [37], which found that fetal head impaction and prolonged labor caused higher NICU admissions and increased perinatal morbidity in second-stage CDs. Despite a marginally higher neonatal mortality rate in group two (3.3% vs. 1.1%), this difference was not statistically significant, possibly because of sample size restrictions.\u003c/p\u003e\u003cp\u003eThe independent association between CDs performed during the second stage of labor and a threefold increase in intraoperative complications was confirmed by multivariate analysis (AOR\u0026thinsp;=\u0026thinsp;3.3, 95% CI: 1.6\u0026ndash;7.1, p\u0026thinsp;=\u0026thinsp;0.002). Additionally, a history of previous CD was an independent predictor (AOR\u0026thinsp;=\u0026thinsp;3.6, 95% CI: 1.5\u0026ndash;8.5, p\u0026thinsp;=\u0026thinsp;0.004). These results highlight the need for increased intraoperative vigilance in such situations and are in line with previous research [32\u0026ndash;35, 42].\u003c/p\u003e\u003cp\u003eAs one of the first studies from a post-conflict region to examine intrapartum CDs with an emphasis on labor stage and its effects on maternal and neonatal outcomes, the setting adds crucial context: delayed referrals, inadequate infrastructure, and compromised health systems likely affect the timing and complexity of CDs. These contextual factors may account for some of the deviations from expected patterns and emphasize the significance of bolstering obstetric services in post-conflict recovery efforts.\u003c/p\u003e"},{"header":"5. LIMITATION OF THE STUDY","content":"\u003cp\u003eOne notable limitation was the challenge in accurately assessing participants' income and occupational status due to the aftermath of the conflict in the study area, where displacement and unemployment were widespread. This contextual factor may have influenced the socioeconomic variables captured.\u003c/p\u003e"},{"header":"6. CONCLUSION","content":"\u003cp\u003eThis study shows that cesarean deliveries during the first and second stages of labor resulted in notable differences in maternal and neonatal outcomes. Longer procedure durations, higher rates of intraoperative complications, and poor neonatal outcomes were all linked to second-stage cesarean deliveries. The clinical difficulties encountered during this stage of labor were highlighted by the significantly higher prevalence of uterine extension injuries and low APGAR scores in the second stage.\u003c/p\u003e"},{"header":"7. RECOMMENDATIONS","content":"\u003cp\u003eEarly Recognition and Prompt Decision-Making\u003c/p\u003e\u003cp\u003eThe incidence of second-stage CDs and the complications they cause may be decreased with early detection of labor abnormalities and earlier cesarean delivery decisions. It is important to emphasize the use of partograph monitoring and active labor management procedures.\u003c/p\u003e\u003cp\u003eSkilled surgical training\u003c/p\u003e\u003cp\u003eTo reduce maternal trauma during second-stage procedures, training in advanced cesarean techniques is crucial, particularly for handling deeply impacted fetal heads. In this sense, junior obstetricians benefit greatly from simulation-based training and mentoring.\u003c/p\u003e\u003cp\u003eStrengthening Referral Systems\u003c/p\u003e\u003cp\u003eImproving transportation networks and referral systems can help prevent prolonged labors that require second-stage CDs in post-conflict and resource-constrained environments by reducing delays in accessing emergency obstetric care.\u003c/p\u003e\u003cp\u003ePreoperative Risk Stratification\u003c/p\u003e\u003cp\u003eIn order to prevent emergency second-stage procedures, women who have had previous cesarean sections or who have risk factors for labor dystocia should be closely monitored and given advice about the possibility of early intervention.\u003c/p\u003e\u003cp\u003eFuture research\u003c/p\u003e\u003cp\u003eIn low-resource and post-conflict settings, more prospective research is advised to examine the long-term outcomes for mothers and newborns after second-stage cesarean deliveries. Furthermore, research is necessary to determine how instrumental deliveries contribute to the decrease of second-stage CDs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cb\u003eEthics approval and consent to participate\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003e Ethical approval for this study was granted by Mekelle university college of health science ethical board (No. MU-IRB 2063/2023). Written informed consent was obtained from all participants. The study is done in accordance with the Declaration of Helsinki (as revised in 2013) and Good Clinical Practice Guidelines.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eConsent for publication\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eNot Applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eCompeting interests\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis work was supported by the Mekelle university college of health science\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHGG: conceptualization, data curation, project administration, visualization, writing-original draft, writing-review, and editing. MNG: Data curation, supervision, project administration, writing-reviewing and editing. BKR: Data curation, writing review and editing. GKB: writing review, and editing. THW: writing review, and editing\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLyell DJ, Power M, Murtough K, Ness A, Anderson B, Erickson K, et al. surgical techniques at cesarean delivery: a US survey. surg j. 2016;2(04):e119\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evineshree govender. mp, moodley j. second stage cesarean setion at a teritiary hospital in south africa. J maternal-fetal neonatal Med. 2010;23(10):1151\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGedefaw G, Demis A, Alemnew B, Wondmieneh A. A. G. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia : a systematic review and meta-analysis. BMC. 2020:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evineshree govender m mj. second stage cesarean setion at a teritiary hospital in south africa. the journal of maternal-fetal \u0026amp; neonatal medicine. 2010;;23(10):1151-5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVousden N, Cargill Z, Briley A, Tydeman G. AH. S. Caesarean section at full dilatation: incidence, impact and current management. Obstetrician Gynaecologist 2014 jul 1;16(3):199\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcKelvey A, Ashe R, McKenna D. Caesarean section in the second stage of labour: a retrospective review of obstetric setting and morbidity. J Obstet Gynaeco. 2010;30(3):264.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnterscheider J, McMenamin M. Rising rates of caesarean deliveries at full cervical dilatation: a concerning trend. Eur J Obstet Gynecol Repro Biol. 2011;157(2):141\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eU S. Changes in Primary and Repeat Cesarean Delivery. Vital Stat Rapid Release Rep. 2022(21).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNotzon FCCS, Bergsj\u0026oslash; P, Cole S, Taffel SIL, Daltveit AK. Cesarean section Delivery in the 1980's: International comparison by indication. Ame J Obstet Gynecol. 1994;170(2):495\u0026ndash;504.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ. W. Alarming global rise in caesarean births. figures show. 2018;4319(october).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatshidze KP, Richter LM, Ellison GTH, Levin JB, Europe JAM. PMC Funders Group Caesarean Section Rates in South Africa: evidence of bias among different \u0026lsquo; population groups. \u0026rsquo;. 2007;3(0):71\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRudey EL. G. R. 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Caesarean Section Rates. 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChawanpaiboon S, Titapant V. Maternal complication of caesarean section at tertiary center: Siriraj Hospital, Bangkok, Thailand. Afr J Reprod Health. 2022;26(augest):142\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChawanpaiboon S, Titapant V. Neonatal complication of caesarean sections at tertiary center: Siriraj hospital. Bangkok Thail. 2022;26(september):118\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTadevosyan M, Ghazaryan A, Harutyunyan A, Petrosyan VAA. Factors contributing to rapidly increasing rates of cesarean section in Armenia: a partially mixed concurrent quantitative- qualitative equal status study. BMC Pregnancy Childbirth. 2019;6:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteven G, Gabbe M, Jennifer R, Niebyl M, Joe Leigh Simpson M, Mark B, Landon M, Henry L, Galan M, Eric RM, Jauniaux M, PhD et al. Obstet Normal Problem Pregnancies Sci 2017;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoodliar M. Complications following caesarean delivery at King Edward VIII Hospital, Durban, South Africa. Obstet Gynaecol Forum. 2004;14:21\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiMatteo MR, Morton SC, Lepper HS, Damush TM, Carney MF, Pearson M, et al. Cesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychol NHS Centre Rev Dissemin. 1996;15:303\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNielson TF. C/S and intra-operative surgical complications. Acta Obstet Gynecol Scand. 1984;63:103\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong GS, et al. Comparison of maternal and infant outcomes from primary caesarean delivery during the second compared with first stage of labour. Obstet Gynecol. 2007;109:917\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllen VM, O\u0026rsquo;Connell CM. Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour. Br J Obstet Gynaecol. 2005;112:986\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAltman MR. L-R. Prolonged second stage of labour and risk of adverse maternal and perinatal outcomes: a systematic review. Birth. 2006;33:4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCebekulu L. Complications associated with C/ S in the second stage of labour. Int J Gynaecol Obstet. 2006;95:110\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDumont A, De Bernis L, Bouvier-olle MH, Br\u0026eacute;art G. Group. MS. Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet. 2001;358(9290):1328\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurray SF. FS. P. Health sector reform and rise of caesarean with in Chile. Lancet. 1997;349(9044):34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePai M, Sundaram P, Radhakrishnan KK, Thomas K. JP. M. A high rate of Caesarean sections in an affluent section of Chennai.is it cause for concern? Natl Med J India. 1999;12(4):156\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnusha SR, Deepak AV*, Jacob KJ. Maternal and neonatal outcome in second stage cesarean section versus first stage: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4640\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBetran AP, Ye J, Moller B. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Heal. 2021;6:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR. A. Trend And Associated Factors Of Cesarean Section Rate In Ethiopia: Evidence From 2000\u0026ndash;2019 Demographic And Health Survey. Res Artic. 2022:1\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrachi Dahiya S, Agarwal, Najam R. Retrospective Analysis of Second Stage of Cesarean Section and Pregnancy Outcomes: An Observational Study. J South Asian Federation Obstet Gynecol. 2022;14(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eterefayehu belay. lukman yusuf, negash s. a comparative study on first stage versus second stage cesarean section on maternal and perinatal outcome. Ethiop Med J. 2014;52(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSushma Sinha S, Malik, Dixit M. First versus second stage caesarean section: a comparison of maternal and neonatal outcomes. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3477\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoswami DK, Parmar MM, Kunjadiya AN. Study of fetomaternal outcome in second stage caesarean section. Int J Reprod Contracept Obstet Gynecol. 2019 jun;8(6):2169\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eterefayehu belay ly. negash s. a comparative study on first stage versus second stage cesarean section on maternal and perinatal outcome. Ethiop Med J. 2014;52(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSushma Sinha SM, Dixit M. First versus second stage caesarean section: a comparison of maternal and neonatal outcomes. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3477\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evineshree govender m. moodley j. second stage cesarean setion at a teritiary hospital in south africa. J maternal-fetal neonatal Med. 2010;23(10):1151\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnusha SR, DAV, Jacob KJ. Maternal and neonatal outcome in second stage cesarean section versus first stage: a comparative study. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4640\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency cesarean delivery, cesarean delivery done in labor, second-stage cesarean delivery, maternal complication, neonatal complication","lastPublishedDoi":"10.21203/rs.3.rs-6957859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6957859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCesarean 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.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA 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 \u0026lt;\u0026thinsp;0.05 was considered statistically significant at a 95% confidence interval, and the strength of association was measured using the odds ratio.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eA 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\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eWomen 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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 14:24:09","doi":"10.21203/rs.3.rs-6957859/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-08-11T09:40:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-06T07:09:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-14T04:13:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-11T11:45:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-07-11T11:42:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"784e3051-740f-4544-bbfc-a359ed380f67","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T14:24:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 14:24:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6957859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6957859","identity":"rs-6957859","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}