A study of maternal morbidity and mortality in elective and emergency lower segment caesarean section

Abstract

Background: Caesarean delivery being one of the most commonly performed surgical procedures in the world has enormous potential for preservation of life and health. It also poses a greater risk of maternal morbidity and mortality compared to vaginal delivery. Indications for performing caesarean delivery have shown a marked change in recent years and there is a growing concern regarding the rising rate of caesarean deliveries. Although the morbidity has come down over the years, it is important to assess and study the maternal as well as neonatal morbidity and mortality associated with it. Aims and Objectives: The present study was aimed to study and compare maternal morbidity like intraoperative and post-operative complications in emergency and elective caesarean delivery groups, and to study maternal mortality if any, between the two groups and also study neonatal outcome in both the study groups.Material and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, TRR Institute of Medical Sciences, Inole (v), Patancheru (M), Sangareddy (Dist.), Telangana, India. The study subjects selected were pregnant women participants attending the antenatal outpatient department attached to our Medical College consisting of n = 250 subjects who underwent elective and emergency Lower Segment Caesarean Section. The patients were divided into two study groups: those undergoing emergency caesarean section and those undergoing elective caesarean section. For every fourth case of emergency lower segment caesarean section (LSCS), one elective case was studied, since the ratio of emergency to elective lower segment caesarean section was 4:1 in our institution. Results: Maternal morbidity and mortality studied in n = 250 subjects who underwent caesarean delivery, morbidity was found to be more in emergency caesarean delivery group than in elective section. Majority caesarean sections were at term, whereas most of the preterm sections were of emergency group. Haemorrhage was most frequent intra-operative complication in both study groups. Additional procedures like B-lynch, uterine artery ligation, internal iliac artery ligation were seen in both groups. Morbidity associated with second stage sections like uterine incision extension, haemorrhage and difficult extraction was documented. Post-operative complications like anaemia, wound infection, sepsis, prolonged hospital stay, pulmonary oedema, DIC, SICU admission were significantly associated with emergency caesarean sections. Conclusion: Caesarean delivery should be done only when indicated and justified. Only then can we bring down caesarean section rates and the maternal and perinatal complications related to it.