Maternal morbidity in repeat cesarean sections
Abstract
Objective: To study intra-operative and post-operative morbidities in women undergoing repeat cesarean sections.
Methodology: It is a prospective, observational study conducted at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, Kathmandu, from April 14th 2011 to April 13th 2012 The study group consisted of all women undergoing repeat cesarean section (RCS) and related morbidities associated at the time of RCS throughout post-operative period until discharge or followed up visit were studied covering all aspects of management care even at readmission.
Results: A significant association between the number of repeat CS with placenta previa (χ2 test, P value of 0.005), dense adhesion (χ2 test, P value of 0.044) and abnormal scar integrity (χ2 test, P value of 0.020) were noted. Scar dehiscence / rupture was seen in 2/24(8.3%) with scar tenderness and 3/209 (1.4%) without scar tenderness, which appears to be an important finding. Post-operatively: hemoglobin deficit in dense adhesions (ANOVA test, P value of 0.009) was significant. With regards to UTI a significant association was noted in adhesion (χ2 test, P value of 0.005) and prolonged surgery of more than an hour (P value 0.041).
Conclusion: Repeat cesarean section, especially after two cesarean confers perioperative morbidities adversely affecting post-operative recovery. Scar dehiscence and rupture or dense adhesions posing difficult dissection, necessitating forceps application and delivery, inadvertently ending in extension of uterine incision corroborates that RCS continues to contribute to morbidity over subsequent pregnancies.
Key words: Maternal morbidities, previous scar, repeat cesarean section
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