Maternal morbidity associated with repeated cesarean sections

ABSTRACT

Caesarean section is an essential widely practiced procedure. The rate of Caesarean section averages more than 20% in developed world and make up a similar percentage of hospital deliveries in developing countries. This rate has been increasing and likely to increase in future. Morbidity associated with this operative procedure is therefore of increasing concern. Caesarean morbidity includes antenatal risk of spontaneous abortion, ectopic pregnancy, intra operative adhesions, scar dehiscence, injury to surrounding organs, placenta previa and accrete, caesarean hysterectomy and post operative complications of blood transfusions, infections, pneumonia and DVT. In - spite of good pre and post operative care and relative safety of caesarean section in modern obstetrics maternal morbidity progressively increases with increased number of Caesarean sections. The objective of this study was to determine the maternal morbidity in women undergoing repeated caesarean sections. It is a cross sectional study. This study was conducted for a period of 12 months at the department of Obstetrics and Gynaecology, Fatima Memorial Hospital, Lahore. Majority of patients i.e. 64.67% [n = 97] were recorded between age group of 26 - 30 years while 28% [n = 42] were found between age 31 - 35 years and 7.33% [n = 11] were found between age 21 - 25 years. Mean and Standard Deviation were 29.03 +/- 7.96. 13.67% [n = 46] were recorded with previous 3 caesarean section. Among them 28.67% [n = 43] were with previous one caesarean section, 27.33% [n = 41] were recorded with previous 2 caesarean sections and 13.33% [n = 20] were recorded with previous 4 caesarean sections. Dense adhesions were found in 65% [n = 13], 60.39% [n = 28], 27.91% [n = 12] and 26.83% [n = 11] in the previous IV, III, I and II respectively. Scar Dehiscence 19.51% [n = 8], 15% [n = 3], 13.95% [n = 6] and 8.69% [n = 4] were found in the previous II, IV, I and III respectively. Maternal morbidity increases with increased in the number of caesarean sections