Operative Morbidities among Patients with Previous Caesarean Sections

Abstract

Objective: To determine the frequency of different operative morbidities among patients with previous one and previous two caesarean sections. Study Design: Cross sectional study. Place and Duration of Study: Study was carried out in department of Obstetrics and Gynecology of Nishtar Hospital Multan, from 13th January 2016 to 12th June 2016. Materials and Methods: Three hundred and thirty-six women of reproductive age group having previous one or two cesarean sections undergoing emergency or elective cesarean section with gestational amenorrhea of >30 weeks were included. Women with medical illness e.g. cardiac, hypertension, renal, diabetes, uterine anomalies e.g. sub septate or bicornuate uterus were excluded. In all these women, type of maternal morbidities was noted in term of presence or absence of thick intraoperative adhesions, extremely weakened lower uterine segment and wound dehiscence. Results: Age of women ranged between 18 to 45 years with 33.279± 5.33 mean age. Mainstream of the women were between 26 to 35 years. Parity range of this study was from 1 - 4. Mean gestational age was 37.122 ±1.48 weeks, while mean number of previous C section was 1.610±0.48. Dense intraoperative adhesions found in 56.5%, extremely thinned out lower uterine part found in 23.5% and scar dehiscence was found in 13.7% of the total patients. When comparing outcomes in ladies with previous one and previous two cesarean sections, dense intraoperative adhesions was 23.7% versus 77.6% (p=0.000), extremely thinned out lower uterine segment was 31.3% versus 18.5% and scar dehiscence was 29% versus 3.9% respectively. Conclusion: Females with history of recurrent cesarean section have possibility of having several intraoperative morbidities, which could escalate the frequency of maternal illness and deaths.

Keywords

• cesarean section, dense intraoperative adhesions, scar dehiscence.