Study of primary caesarean section in multigravida patients

Neelam Rajput, Priyanka Singh, Yogendra Singh Verma


Background: Caesarean section is the most commonly performed major surgery among women. The aims and objective of this study was to know the incidence of primary Caesarean section in multigravidas, its indications and to know the maternal and foetal outcome among these patients.

Methods: It was a prospective study of primary caesarean section in multigravida admitted at Kamla Raja Hospital, G.R. Medical College and J. A. Group of Hospitals, Gwalior (Madhya Pradesh, India) during the period of 1 year from September 2014 to August 2015. Multigravida with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of > 20 weeks gestation were included. Women with previous abortions and previous section and Pregnancy with medical disorders were excluded.

Results: During the study period of one year, total 8185 deliveries occurred, out of which 3061 (37.39%) underwent caesarean section and 386 (12.61%) were primary caesarean section in multigravida. Out of these multigravida patients who underwent primary caesarean section- most of the patients were unbooked (77.72%). Majority of the cases were direct admission in the hospital (61.13%). Maximum number of the patients were in the age group of 25-30 years (55.95%). Two third of the patients were literate (69.44%) Maximum number of patients were Gravida 2 (49.72%). Almost all of them (95.85%) underwent emergency caesarean section. The most common indication for primary LSCS in multigravida patients was Malpresentation 115 (29.79%) followed by Fetal distress in 71 (18.39%) patients, APH in 71 (18.39%), Obstructed labour in 33 (8.55%), Severe preeclampsia and Antepartum eclampsia in 39 (10.1%), Twin pregnancy in 21 (5.44%). Most common maternal complication was pyrexia 40 (10.36%). Postoperative morbidity was 21.24% among unbooked, 14.25% in Referred, 23.58% in those operated as an emergency, 12.43% in patients belonging to of low socioeconomic status and 3.88%, in patients with moderate to severe anemia. Birth asphyxia was found in 6.21% of neonates. Neonatal mortality was 2.33%. Neonatal mortality is more in Unbooked cases (90.47%).

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 antenatal care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.


Multigravida, Maternal outcome, Neonatal outcome, Primary caesarean section

Full Text:



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.

Sethi P, Vijaylaxmi S, Shailaja G, Bodhare T, Devi S. A study of primary caesarean section in multigravidae. Perspect Med Res. 2014;2:3-7.

Rao JH, Rampure N. Study of primary caesarean section in multiparous women. J Evol Med Dental Sci. 2013;2(24):4-7.

Registrar General, India, 2009 and Office of Registrar General, India, 2011.

Suwanrath-Kengpol C, Pinjaroen S, Krisanapan O, Petmanee P. Effect of a clinical practice guideline on physician compliance. Int J Quality Health. 2004;16:327-332.

Omar AAA, Anza SA. Frequency Rate and Indications of Caesarean Sections at Prince Zaid Bin Al Hussein Hospital-Jordan. JRMS. 2012;19(1):82-6.

Solomon B. The dangerous multipara. Lancet 1932;2:8-11.

Basak S, Lahri D. Dystocia in eutocic multigravida. J Obstet Gynecol India. 1975;25:502-7.

Jacob S, Bhargava H. Primary caesarean section in multipara. J Obstet Gynaecol India. 1972;22(6):642-50.

Marfatlal SJ, Narendrabhi MM. Analysis of mode of delivery in women with previous one caesarean section, J Obstet Gynecol India. 2009;59(2):136-9.

Hickl EJ. The safety of caesarean section. In: Popkin DR and Peddle LJ, Eds. Women's Health Today. London: Parthenon Publishers. 1994:65-70.

Vijaykrishnan M, Bhaskar Rao K. Caesarean deliveries – Changing Trends. In: Arulkumaran S, Ratnam SS, Bhasker Rao K (Editors). The Management of Labour, 2nd Ed, Hyderabad, Orient Longman;2005:351-63.

WHO: Monitoring Emergency Obstetric Care: A Handbook. Geneva, Switzerland: World Health Organization 2009.

Himabindu P, Sundari MT, Sireesha KV, Sairam MV. Primary caesarian section in multipara. IOSR-JDMS. 2015;14(5):22-5.

Unnikrishnan B, Rakshith P, Aishwarya A, Nithin K, Rekha T, Prasanna P et al. Trends and Indications for Caesarean Section in a tertiary care Obstetric Hospital in Coastal South India. AMJ. 2010;3(12):821-5.

Rowaily MA, Fahad A, Alsalem, Mostafa A Abolfotouh. Caesarean section in a high-parity community in Saudi Arabia: clinical indications and obstetric outcomes. BMC Pregnancy Childbirth. 2014;14(92):1-10.

Ajeet S, Jaydeep N, Nandkishore K, Nisha R. Women’s knowledge, perceptions, and potential demand towards caesarean section. Natl J Community Med. 2011;2(2):244-8.

Rouse DJ, MacPherson C, Landon M, Varner MW, Leveno KJ, Moawad AH et al. Blood transfusion and caesarean delivery. Obstet Gynecol. 2006 Oct;108(4):891-7.