DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163846

Maternal and fetal outcome in pregnant women with previous one lower segment cesarean section

Shakun Singh, Vandana Dhama, Rachna Chaudhary, Urmila Karya, Kirty Nanda

Abstract


Background: Cesarean section is one of the most commonly performed abdominal operations on women. Because of increasing incidence of Cesarean sections the no. of patients with previous 1 LSCS is also increasing. Thus proper antenatal counseling and institutional delivery should be done.

Methods: A prospective observational study was conducted at department of Obstetrics and Gynaecology, LLRM Medical College Meerut during one year period from Nov 2015-May 2016. Participants to study the maternal and fetal outcome in pregnant women with previous one LSCS. 200 pregnant women were included in the study and outcomes were studied.

Results: Maternal Outcome: Out of 200 cases 122 patients underwent vaginal birth after Cesarean (VBAC) accounting for 61% and 78 patients underwent 2nd LSCS (76 emergency LSCS and 2 elective LSCS). Out of 76, 55 patients were given trial of VBAC but failed and end up in C-Section showing success rate of 68.92% for VBAC (122 out of 177). Adhesions were found in 21patients out of 78 (26.92%) who underwent LSCS. Uterine rupture seen in 2 patients out of 200 cases (1.0%). Scar dehiscence was seen in 6 out of 78 patients (7.69%). Post-partum Hemorrhage was seen in only 20 (10%) patients. Pre-term Pregnancy occurred in 16 (8%) patients. Caesarean Hysterectomy had to be done in 3 (1.5%) patients. Placenta Previa was seen in 6 out of the 200 patients (3%) and placenta accrete was seen in 1 patient (0.5%). Out of 200 patients, 2 twins were born. The total number of babies born was 201. 8 IUDs occurred out of 201 babies (3.98%) and a total of 25 out of 193 live babies (12.95%) required admission to Neonatal Intensive Care Unit out of which 2 babies died.

Conclusions: Cesarean section should not be always followed by a repeat cesarean section. Patient should have hospital delivery in a well-equipped hospital and complications should be diagnosed at an early stage so that maternal and perinatal morbidity and mortality could be prevented.


Keywords


Maternal outcome, Fetal outcome, Previous one LSCS

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References


Caesarian section accounts for 9% of all births in India. Available from: http://timesofindia.indiatimes.com/india/Caesarian-section-accounts-for-9-of-all-births-in-India/articleshow/13235244.cms.

Mishra US, Ramanathan M. Delivery-related complications and determinants of caesarean section rates in India. Health Policy and Planning. 2002;17(1):90-8.

Corton MM, Leveno KJ, Bloom SL, Spong CY, Dashe JS. William’s Obstetrics 24th edition. 2014. pp. 609.

Short term and long term outcome after cesarean section. Available from: http://www.medscape.com/viewarticle/739458_7.

Corton MM, Leveno KJ, Bloom SL, Spong CY, Dashe JS. William’s Obstetrics 24th edition. pp. 588.

ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists. Int J Gynecol Obstet. 1999;66:197-204.

George A, Arasi KV, Mathai M. Is vaginal birth after cesarean delivery a safe option in India? Int J Gynecol Obstet. 2004;85:42-3.

Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section. Int J Gynaecol Obstet. 2004;87:215-9.

Goel SS, Tiwari M, Hariharan C, Shrivastava DS. Outcome of post caesarean pregnancy and comparison of maternal and foetal outcome following vaginal birth versus repeat caesarean section in a rural hospital. Int J Reprod Contracept Obstet Gynecol. 2013;2(1):16-22.

Vardhan S, Behera RC, Sandhu GS, Singh A, Bandhu HC. Vaginal birth after caesarean delivery. J Obstet Gynecol India. 2006;56(4):320-3.

Goel SS, Tiwari M, Hariharan C, Shrivastava DS. Outcome of post caesarean pregnancy and comparison of maternal and foetal outcome following vaginal birth versus repeat caesarean section in a rural hospital. IJRCOG. 2013;2(1):16-22.

Landon MB, Leindecker S. The MFMU caesarean registry: factors affecting the success of trial of labour after previous caesarean. Am J Obstet Gynecol. 2005;193:1016-23.

Doshi HU, Jain RK, Vazirani AA. Prognostic factors for successful vaginal birth after cesarean section: Analysis of 162 cases. J Obstet Gynaecol India. 2010;60:498-502.

Shah JM, Mehta MN. Analysis of mode of delivery in women with previous one cesarean section. J Obstet Gynecol India. 2009;59:136-9.

Hofmeyr GJ, Say L, Gulmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG. 2005;112(9):1221-8.

Justus Hofmeyr G, Say L, Metin Gu¨lmezoglub A. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG. 2005;112:1221-8.

Guise JM, McDonagh MS, Osterweil P, Nygren P, Chan BK, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 2004;329(7456):19-25.

Singh N, Tripathi R, Mala YM. Maternal and Foetal Outcomes in Patients with Previous Caesarean Section Undergoing Trial of Vaginal Birth at a Tertiary Care Centre in North India. J Preg Child Health. 2014;1:102.

Poddar S. A study of the outcome of subsequent pregnancy following previous cesarean section. Jour of Evol of Med and Dent Sci. 2014;3(06):1466-73.

Gurol-Urganci I, Cromwell DA, Edozien LC, Smith GC, Onwere C, Mahmood TA, et al. Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis. BMC pregnancy and childbirth. 2011;11(1):1.

Mahale AR, Ghodke UP, Bhingare PE. Intra-operative difficulties in repeat cesarean sections-A study of 287 cases. J Obstet Gynecol India. 2008;58(6):507-10.