Introduction: The present study was conducted to evaluate the maternal and fetal outcomes in elective versus emergency cesarean section (CS), performed at a tertiary hospital in southern India. Materials and methods:The study was a prospective observational study conducted at a tertiary referral center in Bangaluru, India. 500 consecutive CS, over 29 months (January 2011 to June 2013), were studied. The questionnaire-based tool was used to collect data from the patient's case sheet, labor record, intra-operative records, and treating clinician. The main outcomes were maternal and early neonatal (< 7 days) severe morbidity.Results: Total of 3393 deliveries took place during the study period. The CS rate was 16%. The emergency CS was 58.4% of all sections. In the emergency CS group, 89 patients (30.4%) experienced at least one intra-operative difficulty/complication against 54 patients (25.9%) in the elective CS group (p = 0.31). The incidence of any postoperative complication was 30.3% and 24.3%, in the elective and emergency CS group, respectively (p = 0.20). The mean (SD) length of hospital stay was 4.57 (1.8) and 4.7 (1.2) days in the elective and emergency CS group, respectively (p = 0.30). There was no maternal mortality. In the emergency CS group, neonates tended to have significantly lower birth weight, APGAR scores at 1 and 5 minutes, had higher morbidity and required NICU more frequently. Conclusion:Although maternal morbidity was similar between the emergency and elective CS patients, the fetal outcomes were worse in the emergency CS patients. Whether this is due to fetal distress or complication as an indication for emergency CS or the result of emergency CS is not clear and could be evaluated in future studies.

Background: Objective of this study was to audit the cases of maternal sepsis and analyze their maternal and fetal outcomes.Methods: A retrospective analysis of cases of maternal sepsis was undertaken for one year. Cases were taken as infection with fever, tachycardia, tachypnea, low oxygen saturation, high or low white blood counts and clinical or laboratory evidence of organ dysfunction and were analyzed. Demographic profile, gestational age at the time of diagnosis, organisms & their sources of infection was noted. Maternal outcomes of abortion, preterm delivery, need for intensive care unit (ICU) / high dependency unit (HDU) stay, blood and blood products, surgical interventions for the control of infection, culture-positive rate, source of organism, antibiotic usage and maternal mortality were analyzed. Fetal outcomes of early fetal demise, preterm birth, intrauterine death, stillbirth and term birth were studied.  Results: There were a total of 2327 deliveries, with 2333 live births during the study period. Twenty-two cases were diagnosed with sepsis, of which 17 survived, and five died. The incidence of maternal sepsis was 9.4/1000 live births & maternal deaths were 22.7%. Ninety percent were in the age group of 21-39 years, 68% were referred, 59% were post-delivery. Fifty nine percent of women who survived, and none of the women who died had medical co-morbidities. Respiratory tract followed by genitourinary tract were the most common source of infection, though culture was negative in 54.5% of the cases. The organisms grown were varied, with Escherichia coli (3/10) contributing to 30% of the culture positive cases. Spontaneous abortion and preterm delivery were 18% each, 36% required surgical intervention, 81% required ICU and 64.7 HDU stay. Seventy-seven had live birth.Conclusions: Maternal sepsis is an evolving preventable health burden. Early recognition requires a high index of clinical suspicion, even in the absence of risk factors. Mortality to morbidity ratio is very high in maternal sepsis. The timing of sepsis determines the fetal outcomes.