ABSTRACT
Objective: to find out the type and frequency of intraoperative complications encountered in patients who had repeat cesarean section
Study design: observational Study
Place and duration: the Gynaecology and Obstetrics Unit - III in Liaquat University Hospital Hyderabad. The study period was from July 2005 to July 2006
Method: this study included the women who had repeat cesarean section during the period from July 2005 to July 2006. These women were divided into three groups, group I [GI] included the women with previous 1 cesarean section, group II [GII] included the women with previous 2 cesarean section and group III [GIII] included the women with previous 3 or more cesarean sections. Intraopratieve complications were noted in terms of dense adhesion [with omentum, bowel, uterus and bladder], extremely thinned out lower uterine segment, scar dehiscence, ruptured uterus, placenta praevia, bladder injury, adherent placenta and fetal demise
Results: out of 240 repeat cesarean sections, cases included in GI were 114 [47.5%], in GII were 90 [37.5%] and in GIII were 36 [15%]. Dense adhesions were found in 26 patients of group I [22.8%], in 32 patients of Group II [35.5%] and in 7 patients of group III [19.4%]. Extremely thinned out lower uterine segment was found in 10 patients of group I [8.7%], in 15 patients of group II [16.6%] and in 3 patients of group III [8.3%]. Scar dehiscence was observed in 9 patients of group I [7.8%], in 4 patients of group II [4.4%] and in 2 patients of group III [5.5%]. Ruptured uterus was seen in 3 patients of group I [2.6%] and in 1 patient of group II [1.1%]. Bladder was injured in 1 patient of group I [0.8%] and in 1 patient of group II [1.1%]. Cesarean hysterectomy was performed due to morbidly adherent placenta in 1 case of group I [0.8%] and in 1 case of group III [2.7%]. Fetal demise occurred due to ruptured uterus in 3 cases of group I [2.6%] and in 1 case of group II [1.1%]
Conclusion: women with repeat cesarean section are at risk of having multiple intraoperative surgical complications, which may increase the rate of maternal and fetal morbidity and fetal mortality