Abstract
Cesarean section is the most common surgery performed with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Previous C-section delivery was a major indication for a repeat C-section delivery. The present study aims knowing the intra-operative difficulties encountered by an obstetrician, in this highly evolved surgical procedure called C-section especially in a repeat C-section. It was a Prospective observational study conducted on 60 cases of repeat cesarean section in c/o previous one cesarean section. Difficulties encountered while operating on cases of previous one cesarean section were noted. The intraoperative complications were compared with respect to adhesions (peritoneal, bladder, bowel, omental etc), blood loss, extension of tears over uterus, bladder injury, scar dehiscence, uterine rupture, need for hysterectomy. In present study, following intraoperative morbidities were encountered- adhesions 38.33%, advanced bladder 20%, excess blood loss 10%, placenta accrete was found in 1.67%,thinned out scar seen in 5% . Bladder injury seen in 1.67% patients. No cases of uterine rupture & bowel injury were noted. None of the patient needs caesarean hysterectomy. In modern obstetric practice, objective is safe motherhood and healthy baby by proper management. From present study, it can be concluded that repeat caesarean sections in c/o previous one cesarean section are associated with increased complications which lead to increased maternal morbidity
 Keywords: Primary Cesarean section , Repeat Cesarean section , Caesarean Section Difficulties.
Highlights
Cesarean section is the most common obstetric operative procedure worldwide
It can be concluded that repeat caesarean sections in c/o previous one cesarean section are associated with increased complications which lead to increased maternal morbidity Keywords: Primary Cesarean section, Repeat Cesarean section, Caesarean Section Difficulties
Adhesion Advance bladder Bladder injury Bowel injury Uterine rupture Thinned out scar Placenta accreta Excess blood loss Caesarean hysterectomy
Summary
Cesarean section is the most common obstetric operative procedure worldwide. The incidence of c-section is continuously increasing for the last couple of decades giving women frequently an obstetric status of “previous cesarean section”. Centers of India.[5] For e.g. The rate of C-section in Chennai is 45%.[6] After any laprotomy it is fairly common to develop scar tissue, adhesions and bladder extension. Scaring and adhesion formation is known to cause increase in the major complication rates from 4.3 to 12.5% depending up an the number of previous cesarean section.[7] Intra peritoneal adhesions have an incidence of 5.5% to 42.5%.[8] Previous C-section delivery was a major indication for a repeat C-section delivery.[9] The present study aims knowing the intraoperative difficulties encountered by an obstetrician, in this highly evolved surgical procedure called C-section especially in a repeat C-section
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