RESUMO
Between 1994 and 1999, of the 44 357 mothers delivered at the Riyadh Armed Forces Hospital (RAFH), 255 patients had four or more previous caesarean sections (CS). This comprised 0.5% of the obstetric population. One hundred and eighty-nine (74%) had four, 52 (20%) five, 12 (5%) six and two (0.4%) patients had seven CSs. Adhesions were severe in 128 (50%), moderate in 18 (7%), mild in 81 (32%) and no adhesions in 28 (11%) cases. The incidence of placenta praevia was five times that of the overall obstetric population (2.4% vs. 0.5%). One case of uterine rupture occurred, an incidence of 4/1000 cases. The incidence of placenta praevia rises with rising CS rate. Patients with multiple CS and placenta praevia should be counselled regarding the possibility of caesarean hysterectomy. Repeat CS is safe and tubal ligation should be advised, but not forced as it is not an absolute indication for sterilisation.
RESUMO
OBJECTIVE: To review all cases of cesarean section in the primigravid mother delivered at the Riyadh Armed Forces Hospital between January 1996 and December 1997. To determine its incidence, describe the clinical indications, outcome and highlight areas of improvement in an attempt to reduce the rate of cesarean section. METHODS: Retrospective case record analysis. RESULTS: During the study period there were 15301 deliveries. The overall cesarean section rate for 1996 was 12% and for 1997 was 13%. The rate of cesarean section in the primigravid was 12%. The rate of cesarean section in primiparas breech was 41%. Cesarean section in the unbooked primiparas was 15% as compared to 12% in the booked ones. Fetal distress with or without failure of progress was the main indication for cesarean section in singleton cephalic presentations. In breech presentations, cesarean section was carried out as an elective procedure in 45% and fetal distress was the indication in 21% of cases. Fetal distress was the main indication in twins. CONCLUSION: The rate of cesarean section in the primiparas was similar to the rate of cesarean section in the obstetric population. The rate of cesarean section in the primiparas breech was slightly higher than cesarean section in the multiparas breech. Fetal distress was the leading indication for cesarean section in twins and those with cephalic presentation. The rate of cesarean section can be safely reduced by reviewing and auditing the primary indication for cesarean section, the Consultants doing frequent rounds on delivery suites and being involved directly in cesarean section decision, careful interpretation of fetal monitoring and allowing more patients with breech presentation to have vaginal delivery under close observation.
