Study of Primary Caesarean Section in Multiparous Women

Abstract

OBJECTIVES:It is a study of the analysis of cases where caesarean section was done for the first time in parous women who had previous vaginal delivery of a viable neonate. The various indications, incidence according to age, gravidity, maternal and fetal outcome were studied. METHODS: It is a prospective study of over 200 cases of caesarean section done for the first time in parous women admitted at Government General Hospital, Basaveshwar Teaching and General Hospital, Sangameshwar Hospital, Gulbarga for a period of 18 months. RESULTS: The primary caesarean section rate was 10.28 percent. Maximum incidence of caesarean section was seen in the age group of 25-29 years and majority belonged to second and third gravid. 68 percent of women did not receive any antenatal care. Malpresentation, ante partum haemorrhage, CPD and fetal distress were most common indications for caesarean section. Post operative morbidity was seen in 14 percent of cases. There was no maternal mortality seen. Perinatal mortality rate was 105 for 1000 live births. CONCLUSIONS: It is clear from our study that Primary caesarean section in parous women is not uncommon. Though to a small extent, they are contributing to rise is total caesarean section rates seen. A parous woman needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate. KEY WORDS: caesarean section, parous women, multiparous INTRODUCTION:There is worldwide increase in caesarean section rates. 1,2 Chile and Brazil have the highest caesarean section rates in the world being 40% and 37% respectively. 3 Mean caesarean rate in Asia is estimated to be 15.9% and 17.8% in respectively. 2 Most of the studies on caesarean section on parous women with previous normal delivery dates back to 1960's and 1970's where cesarean rates were low as 2.5-11.3% annually. 4,5,6,7,8,9,10 A recent study has demonstrated that the primary cesarean rate in 2002 was 13.3% among parous women as compared to 18% among nuliparous women in United States. 4 The relative ease with which some multiparous are delivered in the presence of faulty positions and presentations may account for the false sense of security. 11 The limited research in this area may be due to this false notion. It is for these reasons, we have examined trends in primary cesarean rates among parous women with previous normal vaginal delivery with respect to indications, maternal age and parity and the outcome.

Study of primary caesarean section in multigravida patients

“…Rao JH has shown almost similar results in his study. 3 In the present study, there was no maternal mortality observed. This may be because of availability of better antibiotics, blood and blood product transfusion facilities, safe methods of anesthesia, timely intervention, better surgical techniques and operative skill of obstetrician.…”

“…Study done by Sethi P et al in 100 patients showed almost similar results showing 91% emergency operative and only 9% were electively operated. 3 . Desai E et al also reported fetal distress (25.58%), APH (22.09%), CPD (19.77%) and abnormal presentations (17.44%) as the most common indications for caesarean sections in his study.…”

“…1 Different study related the rise in caesarean section to a change in medical practice and concluded that although indications did not change much over the time, there has been lowering in the overall threshold concerning the decision to carry out a caesarean section. [1][2][3][4] There are many factors that contribute to the variations in caesarean section rates, such as practice culture, practice style, hospital environment, and source of payment, patient's preference, and socioeconomic status. A clinical practice guideline can reduce the caesarean section rates without increasing adverse outcomes (SuwanrathKengpol C 2004).…”

Institutional Study of Primary Caesarean Section Among Multigravida

“…Most common indication in the study by Jyothi and Nirmala and Jacob and Bhargava, were malpresentations and antepartum hoemorrhage. 12,13 In another study, antepartum or intrapartum foetal distress was leading indication in 41 percent of women, failure to progress being second cause. 14 Presumed foetal compromise in our study was 25.21%.…”

Estimation of various associated factors in multiparous females undergoing primary caesarean sections at a tertiary care health centre in rural Western Maharashtra, India

“…3 Multipara means those who had delivered one or more foetuses after the age of viability i.e 28 weeks. 4 Primary caesarean section in the multipara means first caesarean section done in the patients who had previously delivered vaginally once or more.…”