Lower Segment Caesarean Section Research Articles

FETO-MATERNAL AND NEONATAL COMPLICATIONS ASSOCIATED WITH HYPOTHYROIDISM IN PREGNANCY

Objective: To analyze and report the maternal, fetal, and neonatal complications in Antenatal hypothyroid women and to give the frequency of the co-existence of Anemia with Hypothyroidism in pregnancy. Methods: A Prospective and an observational study was conducted on 200 Antenatal hypothyroid women admitted to the Obstetrics ward. In the period of 6 mo (August 2022-January 2023), the study was carried out through the examination of medical records of Antenatal women with Hypothyroidism. Results: Of 200 Antenatal hypothyroid women enrolled in the study, Denovo Hypothyroidism was seen in 56% of women. Maternal complications reported include–(Lower Segment Cesarean Section) LSCS seen in 54.5%, Preeclampsia in 19%, mild anemia in 28%, (Post-Partum Hemorrhage) PPH in 7.5%,(Premature Rupture Of Membranes) PROM in 11.5%, Oligohydramnios in 24.5% of women. Fetal complications found were in fetal distress in 21%, in 32.5 %, Respiratory distress in 17.5%, and Low birth weight in 16% of Neonates. Conclusion: Our study concludes that the number of pregnant women affected by Hypothyroidism has increased to a larger extent. Hence, the suspected risk factors of Hypothyroidism have to be addressed and monitored closely to decrease the rate of feto-maternal and neonatal complications in pregnancy, vital for the overall well-being of hypothyroid mothers and their babies.

A Retrospective Study on Clinical Outcomes of Pregnancy-Related Acute Kidney Injury Patients at a South Indian Tertiary Care Hospital.

Introduction Acute kidney injury (AKI) significantly contributes to maternal morbidity and mortality in developing nations. In a retrospective study conducted at our tertiary care center in collaboration between the Department of Nephrology and the Department of Obstetrics and Gynecology, we investigated patients admitted with pregnancy-related acute kidney injury (PR-AKI) under the following parameters: incidence, etiology, and maternal outcomes. Methods We evaluated 70 patients admitted with PR-AKI from May 2016 to August 2020. A thorough evaluation was carried out for these patients. The results were analyzed for the association of mortality with the etiology of PR-AKI and the dialysis requirement. Results The mean age among the PR-AKI patients was 24.56 ± 4.2 years. During the study period, there were 33,403 deliveries, consisting of 20,126 vaginal deliveries, and 13,277 were performed via a lower segment cesarean section (LSCS). Seventy patients developed AKI, with an incidence of 2.9 per 1,000 deliveries. The various etiologies included sepsis in 54 cases (74.3%), preeclampsia/eclampsia in 44 (62.85%), LSCS in 27 (38.6%), abruptio placentae in 11 (15.7%), postpartum hemorrhage (PPH) in 11 (15.7%), post-abortion in eight (11.4%), and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in seven (10.46%). The number of patients in various stages of AKI was noted as one in Stage I, 22 in Stage II, and 47 in Stage III. The odds ratio of death in the abruptio placentae was 0.73 (95% CI: 0.08-6.72), whereasamong those with PPH, it was 1.96 (95% CI: 0.34-11.29). The odds ratio of death among patients with LSCS was 0.50 (95% CI: 0.09-2.64). Out of the total, 34 patients (48.6%) required renal replacement therapy (RRT) provided as intermittent hemodialysis. In total, there were eight deaths (11.3%). The odds ratio of death in dialysis patients was 1.89 (95% CI: 0.42-8.54). Perinatal mortality was 32.9%, whereas total perinatal mortality among all patients was 3.5%. The odds ratio of perinatal mortality among those with AKI was 13.29 (95% CI: 8.05-21.96) with p < 0.0001. Conclusion Our study demonstrates that sepsis was the most common cause of PR-AKI, which can be attributed to a lack of antenatal and postnatal care. Other causes included preeclampsia, LSCS, and hemorrhage. The present study also shows that a significant association exists between PR-AKI and perinatal mortality. The requirement of RRT in AKI predicts a less favorable prognosis.

Evaluation of Mode of Delivery and Various Postnatal Factors on Acquisition of Oral Streptococcus mutans in Infants: A Prospective Study.

The objective of the current study is to assess and establish a relationship between the mode of delivery and postnatal factors in the early colonization of Streptococcus mutans (S. mutans) in infants' oral cavities. The primary goal of the investigation is to assess and compare the oral microflora of newborns immediately after birth and at 3, 6, 9, and 12 months of age in babies born by normal vaginal delivery and lower segment cesarean section and divided into (group III) and (group V), respectively. Around 50 mother-baby pairs in total had their swab samples collected for the identification of S. mutans and were monitored for a year. The role of other postnatal factors in the acquisition of S. mutans in infants was also evaluated. Data analysis showed that different postnatal factors like feeding patterns, oral hygiene practices, and socioeconomic factors affected the infant's oral cavity's initial colonization by S. mutans. Infants' first exposure to oral S. mutans depends on the delivery method and various postnatal factors. Sharma N, Bhargava N, Boruah B, et al. Evaluation of Mode of Delivery and Various Postnatal Factors on Acquisition of Oral Streptococcus mutans in Infants: A Prospective Study. Int J Clin Pediatr Dent 2023;16(5):663-666.

A CLINICAL PROFILE AND RISK FACTORS IN VENTRAL HERNIA PATIENTS: A RETROSPECTIVE STUDY

Introduction: About 4% of all hernia patients admitted to the ward had ventral hernias. Obesity, wound infections, malnutrition, immunosuppression, and inappropriate suture materials or incorrect suture placement were important causative factors for ventral hernia. Methods: This retrospective study was carried out among 50 patients of ventral hernias. Data were compiled in a pre-designed proforma using information from clinical notes, discharge summaries, and operation notes. This study excluded patients under the age of 18, those with femoral, inguinal, or posterior abdominal wall hernias. Results: The most common subtype of ventral hernia was incisional hernia (54.0%). The most common presenting symptom was swelling only (60.0%). The most common associated risk factor was obesity (36.0%) and constipation (26.0%). About 48.0% hernia occurred following gynecological procedures (hysterectomy - 22.0%, lower segment cesarean section - 8.0%, and tubectomy - 8.0%). Conclusion: The most common ventral hernia is the incisional hernia, which often occurs after obstetric and gynecological surgeries. Surgical site infection, obesity, and constipation increase the risk of ventral hernias.

COMPARISON OF CONTINUATION OF POST-PLACENTAL INSERTION OF COPPER T AFTER CESAREAN SECTION AND NORMAL VAGINAL DELIVERY

Objective: The objective of this study was to assess the efficacy of post-placental copper T insertion following vaginal and cesarean delivery. Methods: This is a prospective study conducted for the period of 1 year on pregnant females undergoing deliveries at Department of Obstetrics and Gynecology, Sardar Patel Medical College and AGH, Bikaner. The total number of postpartum intrauterine contraceptive device inserted participants included in the study were 200, divided into two groups vaginal (group A) and lower segment cesarean section (LSCS) (group B) groups. Results: Mean age of the patients was 26.15±4.02 years. Most of the acceptors in both the groups were para-2 with 30% in vaginal group and 76% in LSCS group. The complaints at 6 weeks follow-up, in both groups, were similar, but the rate of removal was higher in vaginal group (9%) compared to LSCS group (2%). At 3 months follow-up, in vaginal group, the most common complaint was bleeding per vagina (PV) in 7.31% cases whereas missing thread 31.25% in LSCS group. Over a period of 3 months, the main reason for intrauterine contraceptive devices (IUCD) removal was bleeding PV in both group (six cases in vaginal group and three cases in LSCS group). Conclusion: Immediate post-partum insertion of IUCD appears to be safe and effective method of contraception.

Development of a multivariate predictive nomogram among women with antepartum fetal death diagnosed at ≥ 34 weeks of gestation for outcome of TOLAC.

The present study was planned to develop a nomogram that will give a priori estimate on the probability of vaginal birth from maternal features in women with antepartum fetal death diagnosed at ≥ 34week's gestation and previous one low transverse cesarean section (LTCS). This will help to reduce maternal complications and increase confidence when planning a trial of labor after cesarean section (TOLAC). A prospective observational study was planned where participants underwent induction of labor with Foley's catheter (unless already in spontaneous labor) within 24h of enrolment. Participants with absent or inadequate contractions, oxytocin infusion as an additional agent was used. Data was collected on maternal predelivery features. Outcome of participants was categorized into two classes-vaginal and cesarean delivery. Classifiers were trained with data on maternal features and the accuracy of predicting outcome class determined. The classifier with maximum accuracy was used to develop a nomogram. Three hundred and one women underwent treatment as per protocol. Two hundred and twenty women attained successful vaginal delivery and eighty-one women underwent caesarean section. Factors having a significant impact on outcome were maternal body mass index (BMI), bishop score, duration of augmentation, estimated foetal weight, interval from previous LTCS, admission to active labor interval, vaginal delivery after LTCS and gestational age. The Naïve -Bayes model gave the highest prediction accuracy (0.88). Non-linear classifiers by using selective features could predict the outcome of TOLAC among women with intra-uterine fetal death attempting vaginal birth at or beyond 34weeks gestation with high accuracy.

Successful Pregnancy Outcome in end-stage Renal Disease (ESRD) Patient : A Case Report

Pregnancy in women with chronic kidney disease (CKD) has always been considered as a challenging event both for the mother and the fetus . Outcomes of pregnancy in patients with End stage renal disease ( ESRD ) have long been considered to be extremely poor and challenges are harder in ESRD patients undergoing maintenance hemodialysis( MHD) . The cases of successful full term pregnancy occurring in an ESRD patient are still very few in whole world even after the evolutionary improvement of medical care. Development of well established multidisciplinary center make it possible to bring a successful pregnancy outcome among ESRD patients who are on going MHD. Patients with CKD are usually amenorrheic and fertility is markedly reduced . Women with chronic kidney disease, who get pregnant have poor pregnancy outcome in term of fetus and mother. Here we report a case of 34 years old lady, mother of two children , housewife presented in Bangladesh Specialized Hospital with a diagnosis 3 rd G 29 weeks of pregnancy with ESRD (on maintenance hemodialysis) with Hypertension. She was treated conservatively with joint consultation with Consultant Obstetrician, Nephrologist and Pediatrician. Her elective Lower uterine segment Cesarean section (LUCS) was done at her 35 weeks of pregnancy due to fetal distress with previous history of 2 LUCS. Both the mother and baby were healthy while discharge from hospital. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 162-164

Complete transverse transection of the normal-sized non-pregnant uterus associated with wearing a safety belt in abdominal blunt trauma: Narrative review and case study.

This review and case study illustrates a patient with a complete transverse transection of a non-pregnant uterus caused by blunt trauma associated with wearing a safety belt. The 31-year-old patient, who had a previous cesarean section, presented with impending hypovolemic shock caused by intra-abdominal hemorrhage secondary to blunt trauma while wearing a safety belt. On physical examination, a transverse straight line of ecchymosis along the line of a fastened safety belt was noted without any other external injury. The operative findings revealed a complete transverse transection which had cut through the lower part of the non-pathological, normal-sized uterus with active bleeding and mild injury to the small bowel without active bleeding. Total hysterectomy and simple closure of the small bowel were performed with successful outcomes. We hypothesize that transection was caused by the enormous pressure produced by blunt trauma transmitted through the abdomen by the fastened safety belt and the weakness of the uterine wall caused by the previous low transverse cesarean section which facilitated the separation and extension to the entire wall. In conclusion, this case study provides the following learning points: (1) Enormous forces produced by a fixed fastened safety belt during a car accident can cause complete transverse transection of a normal-sized, non-pathological uterus, leading to life-threatening intra-abdominal hemorrhage. (2) A previous cesarean section may potentiate the transection, especially when the uterus is repositioned above the pelvic brim. (3) The gynecologic condition should also be included in the differential diagnoses in cases of intra-abdominal hemorrhage. If highly suspected, gynecologists should be notified for early recognition and avoidance of delayed actions.

Prevalence of Undernutrition Among Tribal Lactating Mothers in Andhra Pradesh, India.

Background In Andhra Pradesh, India, tribal communities face unique nutritional challenges due to limited access to healthcare and a predominantly plant-based diet. Maternal undernutrition is a significant concern, impacting the well-being of both mothers and their offspring. This study focuses on assessing the prevalence of undernutrition among tribal mothers in Andhra Pradeshusing the BMI-for-age criterion. Objectives The aim of this study was to comprehensively evaluate the prevalence of undernutrition among tribal mothers, explore associations with demographic factors, and assess the impact of a nutritional intervention program. The ultimate goal was to contribute to targeted interventions and policies for improving the health and well-being of these communities. Materials and methods A cohort study was conducted in the Guntur district of Andhra Pradesh, involving 340 lactating mothers and their infants. Data collection and anthropometric measurements were performed. Results The study found that 67 (19.71%) of tribal mothers were underweight at baseline. There were statistically significant associations with the Yenadi tribe, low educational status of the mother, and history of lower segment Caesarean section with a high prevalence of being underweight. No significant associations with age, occupation, or socioeconomic status were observed. Undernutrition was more common among mothers with older children and was associated with specific obstetric factors. Conclusion While the prevalence of undernutrition is lower than in some previous studies, it remains a critical concern, particularly within disadvantaged communities. These undernourished mothers face health risks, including anemia. Urgent policy interventions and nutritional programs are needed to address this issue and enhance the well-being of tribal communities in Andhra Pradesh.

Dengue in Pregnancy

Dengue is the most common virus-borne illness transmitted by mosquitoes. Globally, the incidence of dengue increased from 30,668,000 in 1990 to 56,879,000 in 2019. It is a significant issue for global public health, especially in the subtropical and tropical regions. Over 2.5 billion people live in regions where there is a 40% chance of getting dengue virus as reported by the World Health Organization. Tropical regions are been more frequently visited by pregnant women and adults of reproductive age. Consequently, they are being exposed to particular arboviral illnesses like dengue, which may affect both current and future pregnancies. A 24-year-old primigravida with 35 + 2 weeks gestational age was referred to the hospital with eclampsia with thrombocytopenia with dengue IgM positive (mildly) in the emergency department. An emergency lower-segment cesarean section was performed. A 2 kg of male baby was delivered. The patient received conservative care for 10 days, and after that, she was discharged with her baby. There are more incidences of infection during pregnancy, due to the rising occurrence of dengue during adulthood. Conservative therapy should be used, if there are no complications. Early detection and treatment are necessary for dengue during pregnancy. Any pregnant lady with a fever during an epidemic requires a high degree of clinical suspicion. The lack of evidence-based data about the treatment of dengue, especially for pregnancy, necessitates further research.

Frequency Of Vaginal Birth After Caesarean Section And Its Fetomaternal Outcome.

Vaginal birth after caesarean section (VBAC) is associated with reduced blood loss and transfusions, fewer infections, and fewer thromboembolic events as compared to caesarean delivery. The current rate of repeat caesarean after one previous caesarean is above the WHO standard of 15%. We aimed to determine the occurrence of VBAC and to determine the occurrence of feto-maternal outcomes in successful VBAC cases so that trials of VBAC can be given to carefully selected patients to reduce the rate of repeat caesarean section. The Combined Military Hospital (CMH) Rawalpindi's Obstetrics and Gynaecology department conducted this cross-sectional study from March 20 to September 19, 2021. After obtaining ethical committee approval, data was collected using a non-probability, consecutive sampling technique from 150 patients on a self-developed structured proforma. Patients between the age range of 20-35 years with a history of previous lower segment caesarean section, having gestational age between 37-41 weeks and who presented in spontaneous labour were included in this study. After taking informed consent, all women were given a trial of labour and the outcome of the trial was noted. Women were followed for the feto-maternal outcomes. The gathered information was analysed using SPSS version 25.0. Post-stratification, a p-value of 0.05 or lower on the chi-square test was deemed statistically significant. Following a C-section, 28.67% of patients experienced successful vaginal births. PPH was found in 2.32%, scar dehiscence in 0.0%, low birth weight babies in 16.28%, APGAR score <7 at 1 minute was 23.26% and NICU admission as 9.30% in women undergoing vaginal birth after caesarean section. Appropriate selection of patients for the trial of VBAC can help reduce the higher rate of repeat caesarean section after a previous caesarean section and increase the chances of successful vaginal birth.

ISOBARIC LEVOBUPIVACAINE VERSUS HYPERBARIC BUPIVACAINE IN PREGNANT WOMEN UNDERGONE CESAREAN SECTIONS: A RANDOMIZED CONTROLLED TRIAL

To compare isobaric levobupivacaine versus hyperbaric bupivacaine for pregnant women who have undergone cesarean sections. In this randomized controlled trial, 70 patients with ASA physical status I-II, scheduled i.e for elective lower segment cesarean section (LSCS), were divided into two equal-sized groups (n = 35 each). Group A was treated with 2.5 ml of isobaric levobupivacaine, while Group B was treated with 2.5 ml of hyperbaric bupivacaine. Both groups' sensory and motor block features were evaluated using the pinprick test and the Bromage scale. Additionally, any instances of hypotension and potential side effects were meticulously recorded. Subsequently, the collected data underwent statistical analysis employing appropriate tests. The initiation of sensory blockage was observed to be slower, and the regression duration for two segments was extended while using isobaric levobupivacaine (p &lt; 0.001). Nevertheless, it generated sufficient surgical anesthetic with a reduced duration of motor blocking and fewer side effects compared to hyperbaric bupivacaine. This study concludes that single-shot spinal anesthesia with different local anesthetics is effective for prompt surgical anesthesia induction in elective cesarean section procedures. Among these options, levobupivacaine is a superior choice due to its smaller duration of motor block, reduced side effects, and lower risk of hypotension, making it particularly well-suited for such procedures.

Comparison of Intravenous Dexmedetomidine and Tramadol for Management of Post-Spinal Anesthesia Shivering in Obstetric Cases

Objective: The objective of this study is to compare the efficacy of dexmedetomidine and tramadol in controlling postspinal anesthesia shivering in female patients after cesarean section. Study Design and Setting: Quasi-experimental Study. Anesthesia Department of Combined Military Hospital, Thal from October 2022-March 2023. Methodology: This study was conducted in ASA I and II patients aged 18-45. Sixty patients were enrolled for the study, who were divided into two group, group D received Inj dexmedetomidine (0.5mcg/kg) while group T received Inj Tramadol (0.5mg/kg). Time from injection of drug to cessation of shivering was recorded. End point of study was 30 mins after entry of patient in Post Anesthesia Care Unit (PACU). Results: The study found that both drugs were effective in preventing shivering, but dexmedetomidine had a faster onset of action and a longer duration of action than tramadol. Mean time of cessation of shivering in both groups was calculated. In group D mean time of cessation was 2.9 ±0.9 while in group T it was 3.75 ±0.9. P-value was found to be highly significant 0.001. Conclusion: The study concludes that dexmedetomidine is a more effective and safer alternative to tramadol for management of shivering in patients undergoing lower segment cesarean section under spinal anesthesia.

FREQUENCY OF SCAR DEHISCENCE IN PATIENTS WITH PREVIOUS ONE CAESAREAN SECTION HAVING SCAR TENDERNESS

Objectives: To determine the frequency of uterine scar dehiscence in patients with previous one cesarean section having scar tenderness. Materials and Methods: This Descriptive Cross Sectional Study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 28th Jan 2021 to 28th July 2021. Total 222 pregnant women with singleton pregnancy more than 28 weeks of gestation and history of previous one lower segment Caesarean Section presenting with scar tenderness were included in the study while patients having previous classical caesarean section, multiple pregnancies, not fi t for VBAC and without scar tenderness were excluded .Study was started after taking approval from IREB. Sampling was done in consecutive manner and followed to determine the occurrence of scar dehiscence. Results: The mean age of the participants was 27.1 + 5.3 years and mean BMI was 25.2 + 2.5kg/ m2 . The mean gestational age was 38.7 +1.9 weeks. Among the participants 43.7% had parity of 1-4 and 56.3% had more than &gt; 5. Maternal tachycardia was present in 32% and on follow up, scar dehiscence was recorded in 14.9%. Conclusion: Scar dehiscence after previous CS is relatively common in women presenting at term pregnancy with scar tenderness. Further studies are recommended on relationship between CS, common factors which can lead to scar dehiscence and its outcome mother and new born.

Clinicopathological features of gestation course associated with uterine scar dehiscence in women with a past medical history of a single caesarean section

Aim. To compare the clinicopathological features, the course of pregnancy and its outcomes with the results of histological examination of the uterine scar in women with a past medical history of a single caesarean section.Materials and Methods. We analysed the associations between histological features of scarred myometrium and clinicopathological parameters of 48 pregnant women aged 19 to 40 years with a past medical history of a single caesarean section. All women were divided into two groups depending on the uterine scar condition. Tissue sampling for histological examination was performed during lower segment caesarean section from the scar area after fetal extraction.Results. 26 women had non-defective uterine scar and 22 women had uterine scar dehiscence (an overstretched inferior uterine segment with little or no muscle fiber and disorganised connective tissue at histological examination). Clinicopathological parameters associated with a uterine scar dehiscence were are ≤ 2-year interval between deliveries (OR = 6.85, 95% CI = 1.27-36.90, p = 0.025) and obesity (OR = 3.5, 95% CI = 0.97-12.70, p = 0.056). Typical pregnancy complication in patients with uterine scar dehiscence was placental insufficiency (OR = 4.75, 95% CI = 1.39-16.2, p = 0.013).Conclusion. Identification of the risk factors for uterine scar dehiscence may assist in selecting a method of delivery for women with a past medical history of caesarean section.

The Impact of the Association Between Nonalcoholic Fatty Liver Disease and Intrahepatic Cholestasis of Pregnancy on Maternal and Fetal Outcomes.

Backgroundː Intrahepatic cholestasis of pregnancy (ICP), a hepatic condition that causes severe itching in late pregnancy, is linked to nonalcoholic fatty liver disease (NAFLD) due to disrupted bile acid balance. It poses maternal risks such as preterm labor and gestational diabetes and fetal risks such as preterm birth and respiratory distress. The study examined NAFLD's impact on ICP in pregnant women, highlighting management and research implications. Methodsː This retrospective study examined pregnant women (≥18 years) with ICP, assessing fatty liver with follow-up ultrasounds. Participants were divided into ICP only and ICP with fatty liver (FL) groups, excluding heavy alcohol users and incomplete data. Maternal age, medical history, and comorbidities were evaluated alongside abdominal ultrasounds to identify FL. Resultsː In this study of 43 pregnant women, the mean maternal age was 27 years. Patients with ICP and FL had significantly higher bile acid levels than those with ICP alone. However, no significant differences were found between the two groups regarding the history of gestational diabetes mellitus (GDM), dyslipidemia, polycystic ovarian syndrome (PCOS), parity, and hypothyroidism. Among women with ICP and FL, 51.85% underwent lower segment cesarean section (LSCS), while 43.75% with ICP without FL underwent LSCS. Conclusionsː ICP with FL did not show significant adverse effects on maternal and neonatal outcomes, including mode of delivery, gestational age, maternal complications, neonatal intensive care unit (NICU) admissions, and low birth weight (LBW) with asphyxia. However, additional research is required to fully comprehend the relationship between ICP, NAFLD, and their impact on pregnancy outcomes.

Comparison between intravenous carbetocen and rectal misopristole as prophylaxis for postpartum hemorrhage in lower segment caesarean section among low-risk patients.

Comparison between intravenous carbetocen and rectal misopristole as prophylaxis for postpartum hemorrhage in lower segment caesarean section among low-risk patients.

Impact of Primary Cesarean Section on Grand Multiparous Women

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section. Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications. Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017. An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded. Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%. Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%. Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency.

Incisional herniae following lower segment caesarean section: A 20-year chart review

Introduction: The rates of caesarean delivery is increasing worldwide as well as in Sri Lanka. Incisional hernia is a known complication of abdominal surgery. To our knowledge there has been no study to assess the incidence of incisional hernia following caesarean section in Sri Lanka. This study was to assess the incidence of incisional hernia requiring surgical repair after lower segment caesarean section (LSCS) in a cohort during a 20-year period.Methods: This was a chart review based on tertiary care private sector hospital in Sri Lanka. Hernia repairs performed during 2002 to 2022 were identified. The data was retrieved from computer based data base and previous bed head tickets. The main inclusion criterion was a caesarean delivery from the 01st of January 2002 to 31st of December 2022 in women with no history of previous abdominal surgery. The cohort was assessed from their first caesarean delivery until 20 years in the inclusion period for an event of hernia repair. The following exclusion criteria for the hernia repairs were used: Diastasis rectiwithout hernia, hernia not in the caesarean incision, and no hernia. The study was approved by the Research and Ethical Committee of Nawaloka Hospital Sri Lanka. The patient records and the data-set were anonymized before analysis. No conflict of interest.Results: There were 2675 records retrieved. The mean age of the patients was 28±7.5 years. There were 10/2675 (0.37%) patients were found to incisional herniae following LSCS. The majority (7/10) of patients with incisional hernia had lower midline incisions for their LSCS. The average time duration of the occurrence of incisional hernia following a single LSCS was 19.5±2.3 months and it was 14.3±1.6 and 12.3±1.5 months for following second and third LSCS respectively. Majority of the incisional herniae were done as routine cases. Following the incisional hernia repair one patient had a recurrence after year.Conclusion: The overall incidence of having an incisional hernia requiring repair of a caesarean delivery was 0.37%. Most herniae appeared within the first two years and associated with the lower midline incisions.

A comparative study to evaluate abdominal wall dynamics in patients with incisional hernia compared to healthy controls.

Incisional hernia is a common complication following abdominal surgery. It causes change in function of core abdominal muscles leading to change in abdominal wall dynamics. This study aims to objectively measure and compare preoperative abdominal wall dynamics with surface electromyography (sEMG) in incisional hernia patients with healthy individuals. In this prospective comparative study, two groups of participants as cases and controls were evaluated for their abdominal wall dynamics by using sEMG. Both cases and controls were evenly matched in terms of age and gender. Statistical analysis was done with STATA 14.1 and p value of < 0.05 was considered significant. Demographic profile was comparable between the two groups. Mean BMI of cases was higher than controls. The most common index procedure was lower segment cesarean section. The strength and power of all three abdominal wall muscles (rectus abdominis, external oblique, internal oblique) were significantly diminished among cases compared to controls. Abdominal wall dynamics can be objectively and correctly interpreted from sEMG of abdominal wall core muscles in patients with incisional hernia. This study shows that there is a decrease in abdominal wall strength and power in patients suffering from incisional hernia in comparison with healthy controls.