Feto-maternal outcome in previous one cesarean section: a retrospective observational study at a district hospital of Jharkhand

Abstract

Background: Cesarean section is one of the most common surgery done in department of obstetrics and gynecology. It becomes more complicated in cases of high risk pregnancy like PIH, APH etc. Its rate is increasing day by day. Once a CS, always a CS, is questionable but being followed up at various set up due to various reasons. Today, one of the important indications of repeat CS is previous CS which increases the rate of CS in a particular set up and morbidities associated with multiple CS. According to ACOG guidelines, VBAC should be attempted to decrease the incidence of repeat CS and morbidity among them. This study was conducted to analyze the incidence of subsequent CS in previous one CS cases, demographic variables and feto-maternal outcome in previous CS patients.

Methods: This was a retrospective observational study on previous CS patients, carried out in District hospital, Dumka, Jharkhand. The rates, demography and feto-maternal outcome among previous one CS patients were studied during 1 year duration and data was obtained from labor room and medical record department.

Results: Out of 2947 deliveries, 63 patients had previous one cesarean section, the incidence being 2.13%. 39.7% deliver vaginally while 60.3% needed repeat cesarean section. Majority (95.2%) were in 21-30yrs age group, 76.2% were unbooked and 25.4% were tribal population. Maximum (79.4%) were gravid 2 and 93.7% were term. 93.7% had birth space >18 months. Out of 38 repeat cesarean section, 78.9% underwent emergency cesarean section. The most common indication being scar tenderness (39.5%) followed by CPD (15.8%). Intraoperatively, severe adhesions found in 15.8% cases, bladder adherence in 18.4% cases and 2.6% had adherent placenta. PPH occurred in 4.8% cases and blood transfusion or injectable iron therapy required in 25.4% cases. 4.7% had wound infection, 7.9% had prolong hospital stay and 22.2% cases required prolong foley’s catheterization. There was no maternal mortality. 95% babies born alive, 3.2% was stillbirth, 1.5% was IUD and the neonatal death rate was 3.2%.

Conclusions: Previous cesarean section is one of the most important causes of CS in subsequent pregnancies, hence increase in the rates of CS and the morbidities associated with multiple CS among mothers. Thus the decision of CS in primigravida should be taken wisely and practice of CS on demand should be discouraged.