A study on primary caesarean section in multigravida patients at a tertiary care center


  • Sneha A. Mendapara Department of Obstetrics and Gynecology, PDU Medical College and Hospital, Rajkot, Gujarat, India
  • Kamal Goswami Department of Obstetrics and Gynecology, PDU Medical College and Hospital, Rajkot, Gujarat, India




Defensive medicine, Robson’s group 3


Background: Historically, most caesarean delivery took place because of or in association with obstetric complications or medical illness. However, rates of elective primary caesarean deliveries with no clear medical or obstetrical indication are rising dramatically. The most common indication for primary c-section include in order of frequency labor dystocia, abnormal or indeterminate fetal heartrate tracing, fetal malpresentation, multiple gestation, fetal macrosomia. Many other factors that have contributed to the increasing rate of caesarean include improved surgical technique and patient demand and pressure on caregivers to practice “defensive medicine”. The increasing rate of caesarean section is a matter of international public health concern as it increases the caesarean related maternal morbidity and fetal complications as well as the cost of health care as compared to normal delivery.

Methods: This study was carried out in the Department of Obstetrics and Gynecology at PDU Medical College and Hospital Rajkot, Gujarat from January 2021 to June 2022.

Results: The study was conducted on 234 cases, the percentage of primary caesarean section in the study population of PDU Medical College Rajkot was found to be 2.96%. In this study, 38.46% of patients belonged to 26-30 year age group. In this study, 78.63% of multigravida patients were 2nd and 3rd para. There were 41.45% of cases underwent LSCS for foetal distress, 12.39% for antepartum haemorrhage, 12.82% for malpresentation and rest for various other indications. 33.33% of the study population in this study belonged to Robson’s group 3, 26.92% were included in category 4a, 15.81% belonged to category 4b. Among all deliveries 94.87% were live births whereas 5.98% were still births.

Conclusions: Many unforeseen complications occur in women who previously had a normal vaginal delivery. It is recommended that all antenatal patients must be booked and receive proper and regular care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.


Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO working group on caesarean section. WHO statement on caesarean section rates. BJOG. 2016;123(5):667-70.

MOHFW. National Family Health Survey (NFHS-5) 2019-21, 2021. Available at: https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf. Accessed on 20 March 2023.

Solomons B. The dangerous multipara. Lancet. 1934;224(5784):8-11.

Rajput N, Singh P, Verma YS. Study of primary caesarean section in multigravida patients. Int J Reprod Contracept Obstet Gynecol. 2018;7(1):185-91.

Meena N, Parveen S, Nagar T, Meena NK. Study of indications of primary cesarean section in multigravida patients: A retrospective study. Asian J Med Sci. 2022;13(7):145-8.

Hangarga US, Yattinamani B. Clinical study of primary cesarean section in multiparous women. Int J Clin Obstet Gynaecol. 2020;4(2):32-4.

Omar AA, Anza SA. Frequency rate and indications of caesarean sections at Prince Zaid Bin Al Hussein Hospital-Jordan. JRMS. 2012;19(1):82-6.

Desai E, Leuva H, Leuva B, Kanani M. A study of primary caesarean section in multipara. Int J Reprod Contracept Obstet Gynecol. 2013;2(3):320-4.

Lurie S. The changing motives of caesarean section: from the ancient world to the twenty-first century. Arch Gynaecol Obstet. 2005;271(4):281-5.

Catholic Online. Archived from the original on 19 July 2006. Retrieved 26 July 2006.

Time Magazine. 18 June 1951. Archived from the original on 13 April 2009. Retrieved 1 April 2009.

Rousset F. Traite nouveau de l’hysterotomakie ou l’enfantement Caesareanne. Paris: 1581.

Glisson F. A treatise of the rickets: being a disease common to children. Culpeper N, trans-ed. London: P Cole; 1651.

Dunn PM. Hendrick van Deventer (1651-1724) and the pelvic birth canal. Arch Dis Child Fetal Neonatal Ed. 1998;79(2):F157-8.

Smellie W. A Treatise on the theory and practice of midwifery. London: D Wilson; 1752.

Low J. Operative delivery: yesterday and today. J Obstet Gynaecol Can. 2009;31(2):132-41.






Original Research Articles