Lower segment cesarean section [LSCS]; indications and complications at teaching hospital, Faisalabad

ABSTRACT

Caesarean section is one of the commonly performed surgical procedures in obstetric and is certainly one of the oldest operations in surgery. Recently there has been a dramatic rise in the caesarean section rate world wide especially in the developed countries. As primary caesarean deliveries contributed most to the overall caesarean section rate [CSR]. So this is clear that primary caesarean section is an important target for reduction because it leads to an increased risk for repeat caesarean delivery. To have an overview of fetomaternal indications for LSCS at a teaching hospital And to review intra-operative and postoperative complications of LSCS at tertiary care centre. All caesarean sections performed at Obstetrics and Gynecology Unit Independent University Hospital Faisalabad from January 2009 to December 2010 were reviewed. Information was obtained from operation theater and labor ward records. During the study period 100 patients undergone caesarean section. Out of 100 patients, 58[58%] had emergency and 42[42%] had elective caesarean section. The leading maternal indications were previous caesarean section 34 [34%], severe pre- eclampsia 6[6%],post date and failed induction of labor6 [6%], placenta previa 6[6%], and failure of progression of labor 5[5%], PROM3[3%], Pre-PROM3[3%]and cephalopelvic disproportion2 [2%].Major fetal indications include fetal distress9 [9%], malpresentation 6[6%], cord prolapse 3[3%],IUGR 5[5%] and pregnancy complicated by multiple fetuses 7 [7%]. Intraoperative surgical and anesthetic complications were observed in very few patients. Nine babies had perinatal deaths in this study, 8 belonged to emergency and only one baby died in elective group due to aspiration pneumonia. Majority of cesarean section are done in emergency situations and previous CS is the most frequent indication of cesarean section. The most effective mean to control CS is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous Csection, selective vaginal breech delivery and regular audit of C-section as well as early detection of at risk cases and proper referral in time is the key factor in decreasing the cesarean section rate and complications