A study of intra-operative maternal morbidity after repeating caesarean section

Sonali S. Somani, Sunita Sudhir, Shashikant G. Somani, . Bushra


Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sections

Methods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.

Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.

Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.


Intra-operative complications, Morbidity, Repeat cesarean section

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MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends and outcomes. Clin Perinatol. 2008;35(2):293-307.

Lynch CM, Kearney R and Turner MJ. Maternal morbidity after elective repeat caesarean section after two or more previous procedures. Eur J Obstet Gynecol Reprod Biol. 2003;106:10-13.

Waheed F, Muhabat Q, Baloch R, Ahmed W. Maternal complications in repeated caesarean section. Innova J Med Health Sci. 2016;6(2):49-52.

Bates GW Jr, Shomento S. Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol. 2011;205(6):19-24.

Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on ma¬ternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205(3):262-8.

Zia S, Rafique M. Intra-operative complications increase with successive number of cesarean sections: Myth or fact. Obstet Gynecol Sci. 2014;57(3):187-192.

Kushboo, Singh S, Karan A. Intra-op complications: primary versus repeat cesarean section. IOSR-JDMS. 2017;16(4):30-4.

Joseph S, Gilvaz S. A Comparative Study on Intra Operative Problems during Primary versus Repeat Caesarean Sections. Sch J App Med Sci. 2016;4(2A):303-10.

Khursheed F, Sirichand P, Jatoi N. Intraoperative complications encountered in patients with repeat cesarean section. JLUMHS. 2009 Jan;8(01):76.

Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci. 2011 Dec;18(12):1166-85.

Nisenblat V, Barak S, Griness OB, Degani S, Ohel G, Gonen R. Maternal Compilations Associated With Multiple Cesarean Deliveries. Obstet Gynecol. 2006;108:21-6.

Scotti RJ, Young JN, Ho MH, Urologic complications. In: O‟Grady JP, Gimovsky ML, Bayer-Zwirello L, Giordano K (eds.): Operative Obstetrics (2nd ed). Cambridge: Cambridge University Press. 2008;608-637.

Juntunen K, Makarainen L, Kirkinen P. Outcome after a high number (4-10) of repeated caesarean sections. BJOG. 2004;111(6):561-3.

Sarsam SD, Kadem HA. Measuring lower uterine segment thickness using abdominal ultrasound to predict timing of cesarean section in women with scarred uterus at elwiya maternity teaching hospital. KCMJ. 2013;9(2):9-13.

Kirkinen P. Multiple caesarean sections: outcomes and complications. Br J Obstet Gynaecol. 1988;95:778-82.

Lydon-Rochelle M, Holt VL, Easterling TR and Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 2001;345(1):3-8.

Cheung VYT, Constantinescu OC and Ahluwalia BS. Sonographic evaluation of the lower uterine segment in patients with previous caesarean delivery. J Ultrasound Med. 2004;23:1441-7.

Bojold E, Jastrow N, Simoneau J, Brunet S and Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. J Obstet Gynecol. 2009;201:320.

Rosenberg P., Goffinet F, Phillipp HJ. Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus. Lancet. 1996;347(3):281.

Placenta accreta. Committee Opinion No. 529. American College of Obstetricians and Gynaecologists. Obstet Gynecol. 2012;120:207-11.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Obstet Gynecol. 2006;107:1226-32.

Ashraf R, Gul A, Bashir A, Tajammal A. Comparison of maternal complication in elective vs. emergency caesarean section. Ann King Edward Med Coll. 2006;12:288-90.