Critical analysis of surgical difficulties and postoperative morbidities of caesarean deliveries: a rural teaching hospital experiences in silk city, South India

Wills G. Sheela, Chellatamizh M., Mohanambal M.


Background: Caesarean section is the delivery of a fetus through a surgical incision on the uterine wall after 28 weeks of gestation. Objectives of present study were to determine the caesarean section rate, to analyse surgical difficulties and post-operative morbidites in caesarean deliveries and to formulate modalities to reduce morbidity and to ensure safe motherhood.

Methods: Retrospective analysis of caesarean deliveries in Shri Sathya Sai Medical College and Research Institute, Ammapettai from January 2015-2017. Total number of delivery in these two year were 494.Total vaginal delivery-210, Total caesarean delivery-284. Case records of women who had cesarean deliveries were analysed for intra operative complications and post-operative morbidity within the period of their hospital stay.

Results: Total no of deliveries in 2 years were 494. Vaginal delivery was 210 (42.5%). Total caesarean section is 57.5% (n=284). Primary caesarean section rate 33.1% (n=94) and secondary cesarean section rate 66.9% (n=190). 60% of our subjects were un-booked emergency admissions. Majority were between 21-30 years. Youngest is 16yr old with imminent eclampsia, oldest 35yr with previous 3 LSCS with central placenta previa. Non-closure of peritoneum in previous caesarean has increased the risk of adhesions, plastered rectus muscle and bladder adhesion which caused difficulty in reaching lower segment in 62 women. In present study, vertical incision was put on uterus in 4 cases due to adhesions. Difficulty in entering uterine cavity, extension of uterine angle due to thick lower segment and excessive bleeding was seen in cases of repeat caesarean section. Scar dehiscence has increased due to single layer closure of uterus. Scar dehiscence was noted in 41 cases. Bladder injury in 3 cases, adherent placenta over the scar was seen in 5 cases.

Conclusions: Caesarean section rate is increasing. Intraoperative complications and postoperative morbidity is comparatively less in primary caesarean section. More than one morbidity was seen in 60% women who had repeat section. With the growing rate of cesarean deliveries worldwide, women should be counselled that the repeat cesarean are bound with surgical difficulties and complications. If available, it’s imperative to take the senior obstetricians help for better surgical outcome. Anticipation of complications, early decision and active intervention reduces morbidity and prevent mortality as most of the women report for admissions late in labour.


Bladder injury, Dense adhesions, Postpartum hemorrhage, Scar dehiscence

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Kwawukwume EY. Caesarean section. Kwawukwume EY, Emuveyan EE (Editors). In: Comprehensive obstetrics in the tropics Damsona, Ashante and Hittscher; 2002:321-9.

Ainbinder WS. Caesarean section. Decherney AH, Nathan L (Editors). In: Current obstetric and gynaecologic th diagnosis and treatment. 9th ed. McGraw Hill Publishers; 2003:518-30.

Johnson DD. Caesarean Delivery. Gilstrip III CL, Cunningham GF, Vandorstrom JP (Editors). In: Operative nd obstetrics. 2 Edition; McGraw Hill Publishers. 2002:257-73.

Nkwo OP, Onah EH. Feasibility of reducing caesarean section rate at the University Teaching Hospital, Enugu, Nigeria. Trop J Obstet Gynaecol. 2002;19(2):86-9.

Ezechi OC, Fasuba OB, Dare FO. Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities. J Obstet Gynaecol. 2000;20:32-4.

Ojo VA, Okwerekwu FO. A critical analysis of the rates and indication for caesarean section in a developing country. Asia-Oceanic. J Obstet Gynaecol. 1988;14:185-93.

Myus SA, Bennett TC. Incidence of significant adhesions of repeat cesarean section and the relationship to method of prior peritoneal closure. J Reprod Med. 2005;50:659-62.

Garba NA, Mohammed Z. Caesarean Morbidity and Mortality at Aminu Kano Teaching hospital Kano: A two-year review. BOMJ. 2016;8(1):10-14

Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2015 May 20;64(4):1.

Munshi SP, Munsho KS, Mehta AR, Solanki SB. Maternal complications during caesarean section: study of 50 cases. Indian J App Res. 2015;5(12):61-2.

Kumar VCR, Hinder P. Study of surgical difficulties encountered in repeat cesarean sections in comparison with the primary cesarean section. IOSR J Dent Med Sci. 2016;15(1):88-91.

Ramkrishnarao MA, Popat GH, Eknath BP, Panditrao SA. Intra-operative difficulties in repeat cesarean section: a study of 287cases. J Obstet Gynecol India. 2008;58:507-10.

Victoria N, Shlomi B, Barnett GO. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 108(1):21-6.