DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20181909

Pregnancy with previous caesarean section: an overview of adverse fetomaternal sequelae

Joyita Bhowmik, Amit Kyal, Indrani Das, Vidhika Berwal, Pijush Kanti Das, Partha Mukhopadhyay

Abstract


Background: The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. The purpose of this study was to evaluate adverse maternal and fetal complications associated with pregnancies with history of previous caesarean section.

Methods: A cross-sectional, observational study carried out over a period of 1 year from 1st June 2016 to 31st July 2017 in Medical College Kolkata. 200 antenatal patients with previous history of 1 or more caesarean sections were included. In all cases thorough history, complete physical and obstetrical examination, routine and case specific investigations were carried out and patients were followed till delivery and for 7 days thereafter. All adverse maternal and fetal complications were noted.

Results: Out of 200 women, 30 candidates were tried for VBAC, of them 20 (66.66%) had successful outcome. Most common antenatal complication was APH (5.5%) due to placenta praevia followed by scar dehiscence. There were 12 cases (6.66%) of PPH and 6 cases (3.33%) of scar dehiscence in the study group. 3 cases required urgent hysterectomy due to placenta accreta. 42 out of 196 babies required management in SNCU immediately or later after birth.

Conclusions: Women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counselling for trial of labor and proper antepartum and intrapartum monitoring of patients are key to reducing the cesarean section rates and maternal complications.


Keywords


Maternal morbidity, Repeat caesarean section, Scar rupture, Vaginal birth after caesarean section

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References


Mukherjee SN. Rising caesarean section rate. J Obstet Gynecol India. 2006;56:298-300.

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.

Parliamentary Office of Science and Technology. Caesarean sections. Postnote. 2002;184:1-4.

Dodd J, Crowther CA. VBAC: a survey of practice in Australia and New Zealand. Aust N Z J Obstet Gynaecol. 2003;43:226-31.

Latika SA. 10-year analysis of uterine rupture at a teaching institution. J Obstet Gynecol India. 2006;56(6):502-6.

Bhat BPR, Savant R, Kamath A. Outcome of a post caesarean pregnancy in a tertiary centre of a developing country. J Clin Diagn Res. 2010;3:20059.

Kumar P, Shivkumar PV, Jaiswal A, Kumar N, Saharan K. Subjective assessment of LSCS scar site for vaginal birth after caesarean trial and outcome in MGIMS, Sewagram, Wardha, India. Int J Biol Med Res. 2012;3:1825-9.

Huang WH, Nakashima DK, Rumney PJ, Keegan KA Jr, Chan K. Interdelivery interval and the success of vaginal birth after cesarean delivery. Obstet Gynecol. 2002;99:41-4.

Shipp TD, Zelop CM, Repke JT, Cohen A, Lieberman E. Interdelivery interval and risk of symptomatic uterine rupture. Obstet Gynecol. 2001;97:175-7.

Nahar K, Akhter L, Chowdhury SB. Outcome of pregnancy with history of previous cesarean section. Orion Med J. 2008;31:588-90.

Anagha A, Jinturkar D, Dipti. Study of obstetric and fetal outcome of post caesarean section pregnancy at tertiary care center. Int J Recent Trends Sci Tech. 2014;10(3):530-7.

Parikh V. Management of patients with previous caesarean section. J Obstet Gynaecol India. 1964;14:327.

Dutta DC. Textbook of obstetrics including perinatology and contraception, 9th ed. Jaypee, New Delhi; 2018:394

Silver RM, Landon MB, Rouse DJ. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226.

Chowdhury SB, Newaz R, Begum A, Dewan F. Indications and complications of cesarean section: a study of 1083 cases. Bangladesh J Obstet Gynecol. 1994;9:1-7.

Asaduzzaman K. A study on factors and outcome of cesarean section among the patients admitted in a tertiary care hospital, Dhaka, Bangladesh College of Physicians and Surgeons. 1996.

Umbeli T, Ismail S, Kunna A, Elmahgoub A. Maternal and neonatal complications associated with caesarean section in the second stage of labour at Omdurman maternity hospital during 2012-2013. Merit Res J Med Medical Sci. 2014;2(10):225-8.