Maternal and fetal outcome in pregnant women with previous one lower segment cesarean section

Abstract

INTRODUCTIONCesarean section is one of the most commonly performed abdominal operations on women in most countries. Cesareans section aims at reducing maternal and fetal mortality and morbidity by virtue of its cautions and careful approach. In many countries, C-sections have become the mode of delivery in over a quarter of all the birth. The World Health Statistics (WHS), 2012, released on Wednesday, said 9% of all births in India were by Caesarian section. The latest figure has gone up by 5% since nearly one in 10 women in India, who gave birth between 2005 and 2010, had gone under the surgical knife.1 Using the data of national family health survey India (1992-93) Mishra and Ramanathan found that among 18 large states two states has CS rate near 15 percent and the rest had less than 5 percent. ABSTRACTBackground: Cesarean section is one of the most commonly performed abdominal operations on women. Because of increasing incidence of Cesarean sections the no. of patients with previous 1 LSCS is also increasing. Thus proper antenatal counseling and institutional delivery should be done. Methods: A prospective observational study was conducted at department of Obstetrics and Gynaecology, LLRM Medical College Meerut during one year period from Nov 2015-May 2016. Participants to study the maternal and fetal outcome in pregnant women with previous one LSCS. 200 pregnant women were included in the study and outcomes were studied. Results: Maternal Outcome: Out of 200 cases 122 patients underwent vaginal birth after Cesarean (VBAC) accounting for 61% and 78 patients underwent 2nd LSCS (76 emergency LSCS and 2 elective LSCS). Out of 76, 55 patients were given trial of VBAC but failed and end up in C-Section showing success rate of 68.92% for VBAC (122 out of 177). Adhesions were found in 21patients out of 78 (26.92%) who underwent LSCS. Uterine rupture seen in 2 patients out of 200 cases (1.0%). Scar dehiscence was seen in 6 out of 78 patients (7.69%). Post-partum Hemorrhage was seen in only 20 (10%) patients. Pre-term Pregnancy occurred in 16 (8%) patients. Caesarean Hysterectomy had to be done in 3 (1.5%) patients. Placenta Previa was seen in 6 out of the 200 patients (3%) and placenta accrete was seen in 1 patient (0.5%). Out of 200 patients, 2 twins were born. The total number of babies born was 201. 8 IUDs occurred out of 201 babies (3.98%) and a total of 25 out of 193 live babies (12.95%) required admission to Neonatal Intensive Care Unit out of which 2 babies died. Conclusions: Cesarean section should not be always followed by a repeat cesarean section. Patient should have hospital delivery in a well-equipped hospital and complications should be diagnosed at an early stage so that maternal and perinatal morbidity and mortality could be prevented.

Study of feto-maternal outcome in previous cesarean section

“…(21 in 78 cases). 1,7,8 Incidence of placenta previa was 0.94% and placenta acreta was not seen in our study. Nazaneen S et al reported placenta previa 4.3% and placenta acreta 2.46%, Singh S et al reported 3% and 0.5% respectively.…”

“…1 Singh S et al reported 8% preterm CS. 8 In the present study perinatal morbidity was 3.32%, mortality was 3.96%. A Sharma et al reported 9.67% babies of elective CS and 2.32% in emergency CS babies were admitted to NICU.…”

“…Nazaneen S et al reported placenta previa 4.3% and placenta acreta 2.46%, Singh S et al reported 3% and 0.5% respectively. 1,8 Incidence of cesarean hysterectomy in our study was 0.15%, Singh S et al reported 1.5%. 8 Nazaneen et al reported 1.53% as the study was done for previous 2, 3 CS, they had 5 cases of placenta acreta required hysterectomy and incidence of thinned out scar was seen in 3.32% and scar dehiscence in 1.06%.…”

Maternal and perinatal outcome of pregnancy in women with one previous caesarean section-a study at a tertiary care centre

“…Incidence of scar rupture was 1% in the study group and 1% in Singh et al study. 9 The maternal morbidity in terms of pyrexia, wound infection, UTI were found to be higher in caesarean group compared to vaginal delivery group which was statistically significant.…”

“…Scar dehiscence was noted in 3.7% of cases in study group as compared to 7.69% in Singh et al study. 9 There were 2 (1%) patients with uterine scar rupture and one case of bladder injury which were repaired. Incidence of scar rupture was 1% in the study group and 1% in Singh et al study.…”