Evaluation of Anaesthesia Technique in Emergency Caesarean Section in a Teaching Hospital of Sub Himalayan Belt - A Prospective Analysis.

ABSTRACT

The number of Caesarean Deliveries has shown a rapid increase in modern obstetric practice. This study was done to evaluate the choices of anaesthetic techniques for the lower segment caesarean section (LSCS) following the patient's clinical condition and its correlation with maternal and foetal outcomes in Dr. Sushila Tiwari Govt. Hospital, Haldwani, Uttarakhand, India. METHODSWe conducted a prospective observational study for one year. We recorded patient's age, parity, American Society of Anaesthesiologist (ASA) physical classification, chronic diseases or any other preoperative comorbid condition, caesarean indication, maternal outcomes, and foetal outcomes. We grouped the anaesthetic techniques used in LSCS as General Anaesthesia (GA) and Subarachnoid Block (SAB). RESULTSOut of a total of 2161 emergency caesarean sections were performed during the study period, 53 were under GA, 2096 under under SAB and in 12 cases SAB was converted to GA. Unlike previous studies, the most common indication of LSCS was previous caesarean (40.1%). In comparison, foetal distress is the second most common cause of emergency LSCS (37.1%). Maternal mortality was 16.9% (11/65) and 0.1% (3/2096) in GA and SAB, respectively (p-value 0.001). Neonatal mortality was 10.8% (7) and 2.4% (50) in GA and SAB, respectively. CONCLUSIONSMaternal and neonatal mortality and complications were higher in the GA group as compared to the SAB group. Also, increased incidence of violence against health care providers and rising lawsuits has led to a sense of insecurity amongst the health care providers which is evident via preference of LSCS in patients with previous history of caesarean section. This is evident from the trend that now previous LSCS is becoming most common indication of LSCS instead of foetal distress as is found in various studies done earlier.