Authors :
Dr. Shamlath M K P; Dr. Menon Nalini Sekharan; Dr. Smitha Santhosh
Volume/Issue :
Volume 8 - 2023, Issue 11 - November
Google Scholar :
https://tinyurl.com/bvrrkusb
Scribd :
https://tinyurl.com/29n7vakn
DOI :
https://doi.org/10.5281/zenodo.10282190
Abstract :
Introduction:
Cesarean section is the most common obstetric surgery performed worldwide to save life of pregnant patient as well
as fetus. However, repeat cesarean sections are associated with increased risk of maternal and perinatal morbidity and
mortality. It is associated with postpartum haemorrhage, sepsis, peripartum hysterectomy, adherent placenta, uterine
rupture and maternal death.
Scarring and adhesion formation is known to cause increase in the complications depending up on the number of
previous cesarean section. As with all types of abdominal surgeries, a cesarean section is also associated with risks of
incisional hernias and wound infections.. Along with the risk of anaesthesia,there is also intra operative risks like blood
loss requiring blood transfusion due to various causes like adhesions, extension of uterine incision, adherent placenta, risk
of previous scar dehiscence, uterine rupture, thinning of lower uterine segment and organ injuries like bowel and bladder
injury. The risk of placenta accreta, a potentially life- threatening condition is increased after two cesarean sections,
increasing the risk of obstetric hysterectomy.In case of elective cesarean section, if not properly timed , neonatal problems
like iatrogenic prematurity and respiratory distress syndrome due to pulmonary immaturity may ensue.Objectives:
My aim is to study the maternal and perinatal morbidity and mortality associated with previous 2 or more cesarean
sections.Methods:
This is a prospective observational study conducted in 200 antenatal women in Department of Obstetrics and
Gynaecology, Government Medical College, Kozhikode, above 34 weeks of gestation, including both elective and
emergency admissions. Data was analysed using SPSS software and the level of significance was employed if p-value < 0.5.Results:
Out of 200 cases randomly selected and studied, who had previous 2 or more cesarean sections 188 had previous two
(96%) and 12 had previous three (4%) cesarean sections. The highest number was between 21 to 30 year age group (58%).
Most had duration of hospital stay between 6 to 10 days (64%). 8.3% of the previous three cesarean sections,had scar
tenderness in contrast to 3.7% of the previous two cesarean sections. . There was 8 cases of abnormal placental invasion
(4%), who underwent obstetric hysterectomy. There was difficulty in opening abdomen in 42% of cases and 153 cases
(76.5%) lower segment was thinned out. 56.5% of the study participants did not have any adhesions, rest of the 87 (43.5%)
participants had occurrence of adhesion as complication. Most common (19%) type of adhesion was between anterior
abdominal wall and anterior wall of uterus. 7 among the 200 participants (3.5%) had bladder injury. There was no cases
of scar rupture, uterine rupture or bowel injury in the study population. Other intraoperative complications included PPH
(3.5%), blood transfusion (9%), tear in lower uterine segment (2%) and pulled up bladder (8%). 13.5% of the babies
were admitted to NICU, in which respiratory distress (13 cases) was the most common indication for NICU admission.In
the current study, individuals who had previously undergone two or three CS had essentially the same percentage of
emergency cesarean sections.Conclusion:
Women with repeat cesarean sections are at high risk of having multiple intraoperative complication that increase
the rate of maternal and fetal morbidity. As the number of repeat cesarean section increases there is increased risk of
maternal morbidities like sepsis, adhesions, organ injury abnormal placentation, scar tenderness, haemorrhage. Patient
should have proper counselling about the risk of repeat cesarean sections, and should be offered permanent sterilisation
after two or more cesarean sections. Effort should be made towards decrease in the incidence of the total cesarean sections
through decreasing in the number of primary cesarean sections and giving proper chance of viginal birth after previous
one cesarean section( VBAC).
Keywords :
Cesarean Section, Morbidly Adherent Placenta, Obstetric Hysterectomy, PPH , Bladder Injury.
Introduction:
Cesarean section is the most common obstetric surgery performed worldwide to save life of pregnant patient as well
as fetus. However, repeat cesarean sections are associated with increased risk of maternal and perinatal morbidity and
mortality. It is associated with postpartum haemorrhage, sepsis, peripartum hysterectomy, adherent placenta, uterine
rupture and maternal death.
Scarring and adhesion formation is known to cause increase in the complications depending up on the number of
previous cesarean section. As with all types of abdominal surgeries, a cesarean section is also associated with risks of
incisional hernias and wound infections.. Along with the risk of anaesthesia,there is also intra operative risks like blood
loss requiring blood transfusion due to various causes like adhesions, extension of uterine incision, adherent placenta, risk
of previous scar dehiscence, uterine rupture, thinning of lower uterine segment and organ injuries like bowel and bladder
injury. The risk of placenta accreta, a potentially life- threatening condition is increased after two cesarean sections,
increasing the risk of obstetric hysterectomy.In case of elective cesarean section, if not properly timed , neonatal problems
like iatrogenic prematurity and respiratory distress syndrome due to pulmonary immaturity may ensue.Objectives:
My aim is to study the maternal and perinatal morbidity and mortality associated with previous 2 or more cesarean
sections.Methods:
This is a prospective observational study conducted in 200 antenatal women in Department of Obstetrics and
Gynaecology, Government Medical College, Kozhikode, above 34 weeks of gestation, including both elective and
emergency admissions. Data was analysed using SPSS software and the level of significance was employed if p-value < 0.5.Results:
Out of 200 cases randomly selected and studied, who had previous 2 or more cesarean sections 188 had previous two
(96%) and 12 had previous three (4%) cesarean sections. The highest number was between 21 to 30 year age group (58%).
Most had duration of hospital stay between 6 to 10 days (64%). 8.3% of the previous three cesarean sections,had scar
tenderness in contrast to 3.7% of the previous two cesarean sections. . There was 8 cases of abnormal placental invasion
(4%), who underwent obstetric hysterectomy. There was difficulty in opening abdomen in 42% of cases and 153 cases
(76.5%) lower segment was thinned out. 56.5% of the study participants did not have any adhesions, rest of the 87 (43.5%)
participants had occurrence of adhesion as complication. Most common (19%) type of adhesion was between anterior
abdominal wall and anterior wall of uterus. 7 among the 200 participants (3.5%) had bladder injury. There was no cases
of scar rupture, uterine rupture or bowel injury in the study population. Other intraoperative complications included PPH
(3.5%), blood transfusion (9%), tear in lower uterine segment (2%) and pulled up bladder (8%). 13.5% of the babies
were admitted to NICU, in which respiratory distress (13 cases) was the most common indication for NICU admission.In
the current study, individuals who had previously undergone two or three CS had essentially the same percentage of
emergency cesarean sections.Conclusion:
Women with repeat cesarean sections are at high risk of having multiple intraoperative complication that increase
the rate of maternal and fetal morbidity. As the number of repeat cesarean section increases there is increased risk of
maternal morbidities like sepsis, adhesions, organ injury abnormal placentation, scar tenderness, haemorrhage. Patient
should have proper counselling about the risk of repeat cesarean sections, and should be offered permanent sterilisation
after two or more cesarean sections. Effort should be made towards decrease in the incidence of the total cesarean sections
through decreasing in the number of primary cesarean sections and giving proper chance of viginal birth after previous
one cesarean section( VBAC).
Keywords :
Cesarean Section, Morbidly Adherent Placenta, Obstetric Hysterectomy, PPH , Bladder Injury.
