Intraoperative surgical difficulties encountered during repeat caesarean section in a tertiary care centre in Northeast India

Authors

  • Korobi Morang Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh, Assam, India
  • Lithingo Lotha Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh, Assam, India
  • Kiran R. Konda Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh, Assam, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20214323

Keywords:

Intraoperative complications, Caesarean section

Abstract

Background: Caesarean section is the commonest obstetric operative procedure worldwide. The potential perioperative problems in repeat caesarean section include adhesions, increased blood loss, prolonged operative time, injuries to adjacent structures, hysterectomy etc. These increase with increase in caesarean section number.

Methods: Hospital based observational study, conducted at Dept. of Obstetrics and Gynaecology, Assam Medical College, from July 2019 to June 2020 with the aim to study intraoperative difficulties encountered during repeat caesarean section. Cases were grouped into two main groups based on number of prior caesarean sections. A detailed history, clinical and intraoperative findings of all pregnant women undergoing repeat caesarean section were noted. Results were tabulated and analysed.

Results: Out of 400 women with prior caesarean section who underwent repeat caesarean. 321 had 1 prior caesarean and rest had 2. Among the cases cephalopelvic disproportion was the commonest (43.25%) indication and obstructed labour was the least common (0.25%). Common complications were adhesions (38.25%), thinned lower uterine segment (27%), advance bladder (19.50%), uterine dehiscence (14.75%), excess blood loss (12.75%), extension of uterine incision (8.25%), uterine rupture (1%), placenta accrete (0.75%), and bladder injury (0.5%). Intraoperative complications like adhesions, uterine dehiscence, delivery and operating time were significantly higher in women with 2 prior caesarean section compared to 1 prior caesarean section (p<0.001).

Conclusions: Women with caesarean scar are at high risk in subsequent pregnancies particularly in a country like India where antenatal care is often neglected. Best technique to reduce multiple potential complications of repeat caesarean section is to reduce the rates of primary and repeat caesarean sections whenever possible.

References

Baskett TF, Calder AA. Caesarean Section. In: Baskett TF, Calder AA, Arulkumaran S, editors. Munro Kerr’s Operative Obstetrics. Saunders Elsevier. 2014;132-44.

Jacob L, Taskan S, Macharey G, Sechet I, Ziller V, Kostev K. Impact of caesarean section on mode of delivery, pregnancy-induced and pregnancy-associated disorders, and complications in the subsequent pregnancy in Germany. GMS Ger Med Sci. 2016;14(6):12-7.

Ramkrishnarao MA, Popat GU, Eknath BP, Panditrao SA. Intra-operative difficulties in repeat cesarean sections–A study of 287 cases. J Obs Gynecol India. 2008;58(6):507-10.

Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol. 2011;205(6):S11-8.

Nisenblat V, Barak S, Griness OB, Degani S, Ohel G, Gonen R. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 2006;108(1):21-6.

Somani SS, Sudhir S, Somani SG. A study of intra-operative maternal morbidity after repeating caesarean section. Int J Reprod Contraception. Obstet Gynecol. 2017;7(1):291-6.

Singh P, Singh S. A study of per operative findings in cases with previous cesarean section. Int J Clin Obstet Gynaecol. 2019;3(1):66-8.

Sinha P, Gupta U, Singh J, Srivastava A, Chauhan S. Per operative findings in repeat cesarean section. Int J Reprod Contraception. Obstet Gynecol. 2016;5(4):1093-6.

Poovathi M, Suilharsini TS. Analysis of repeat LSCS in a tertiary care centre. Int J Reprod Contraception. Obstet Gynecol. 1964;7(5):1964.

Sheela WG, Chellatamizh M, Mohanambal M. Critical analysis of surgical difficulties and postoperative morbidities of caesarean deliveries: a rural teaching hospital experiences in silk city, South India. Int J Reprod Contraception, Obstet Gynecol. 2012;6(6):2566.

Lakshmi JV, Anuradha C, Rishitha M. Intra-operative complications in repeat cesarean sections. Int J Clin Obstet Gynaecol. 2020;4(2):144-9.

Joseph S, Gilvaz S. A Comparative Study on Intra Operative Problems during Primary versus Repeat Caesarean Sections. Sch J App Med Sci. 2016;4:303-10.

Khursheed F, Sirichand P, Jatoi N. Intra-operative Complications encountered in patients with repeat caesarean section. JLUMHS. 2009;8(01):76.

Jhajhria R, Meena P, Kosaraju Si. Comparative study of maternal morbidity in primary and repeat caesarean section. Int J Clin Obstet Gynaecol. 2018;2(2):69-74.

Khursheed F, Sirichand P, Jatoi N. Intraoperative complications encountered in patients with repeat cesarean section. J Liaquat Univ Med Heal Sci. 2009;8(1):76-9.

Morales KJ, Gordon MC, Bates Jr GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007;196(5):461-e1.

Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201(1):56.e1-6.

Downloads

Published

2021-10-27

Issue

Section

Original Research Articles