Published: 2016-12-27

Per operative findings in repeat cesarean section

Parul Sinha, Uma Gupta, Jyotsna Singh, Anand Srivastava, Shilpi Chauhan


Background: Cesarean section is the commonest obstetric procedure done worldwide. Incidence of cesarean section is increasing giving it a term “repeat cesarean section”. Repeat cesarean section makes future obstetrics performances and abdominal exploration risky. After any Laparotomy it is fairly common to develop scar tissue, or adhesion. The scarring and adhesion formation is known to increase the major complications rate from 4.3% to 12.5% depending on the number of previous section. Intra peritoneal adhesions have an incidence of 5.5% to 42.5%.

Methods: An observational prospective study was conducted in Obstetrics and gynecology department of Era’s Lucknow Medical College, Lucknow. Total 80 cases of repeat cesarean sections were included. The case histories and intra operative findings were recorded.

Results: Intra peritoneal adhesions of varied types were seen in majority of cases, out of which the most commonly seen adhesion was between parietal peritoneum and anterior surface of uterus 24(30%) and adhesion between bladder and uterus 24(30%).

Conclusions: Chances of developing adhesions increases with each cesarean section, which leads to increase in morbidity of women. Thus cases of previous cesarean section should be educated about routine antenatal care.


Repeat cesarean section, Maternal mortality, Intra peritoneal adhesions

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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.

Kaplonoglu M, Atilla K, Utku A, Ali B. Complications and outcomes of repeat cesarean section in adolescent women. Int J Clin Exp Med. 2014;7:5621-8.

Qublan HS, Tahat MY. Multiple cesarean sections, the impact on maternal and fetal outcome. Saudi Med J. 2006:210-4.

Aziz FA. Pregnancy and lbor of grand multiparas soudanese women. Int J Gynecol Obstet. 1980;18:144-6.

Seidman DS, Armon Y, Roll D, Stevenson DK, Gale R. Grand multiparity: An obstetric or neonatal risk factor? Am J Obstet Gynecol. 1988;158:1034-19.

Qublan HS, Alghoweri AS, Abu-Khait S, Abu Salem A, Mehej A. Cesarean section Rate: the effect of age and parity. J Obstet Gynecol Res. 2002;28:22-5.

Kaplanoglu M, Bulbul M, Kaplanoglu D, Bakacak SM. Effect of multiple repeat cesarean sections on maternal morbidity: Data from Soth east Turkey: Mustafa Kaplanoglu Med Sci Monit. 2015;21:1447-53.

Nisenblat V, Barak S, Griness OB. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 2006;108:21-6.

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

Sobande A, Eskandar M. Multiple repeat cesarean sections: complications and outcome. JOGC. 2006:193-7.

Khashoggi TY. Higher order multiple repeat cesarean sections; maternal and fetal outcome. Ann Saudi Med. 2003;23:278-82.

Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery; maternal and fetal consequences. Is J Obstet Gynecol. 1993;69:945-50.

Tampakoudis P. Cesarean section rates and indications in Greece: data from a 24 year period in a teaching hospital. Clin Exp Obstet Gynecol. 2004;31:289-92.

O’Dwyer V, Hogan JL, Farah N et al; maternal mortality and the rising cesarean rate. Int J Gynecol Obstet. 2012;116:54-6.

Tulandi T, Agdi M, Zarei A et al; adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201:1-6.

Lyell DJ; Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol. 2011;205:11-8.

Ananth CV, Smulian JC, Vintzileos AM; the association of placenta previa with history of cesarean delivery and abortion: a meta analysis. Am J Obstet Gynecol. 1997;177:1071-8.

Khong TY. The pathology of placenta accrete, a world wide epidemic. J Clin Pathol. 2008;6:1243-6.

William obstetrics; Prior cesarean delivery.F. Gary Cunningham: Mc Graw Hill; 24th edition; 2014:609.