Feto-maternal outcome in previous one cesarean section: a retrospective observational study at a district hospital of Jharkhand

Background: Cesarean section is one of the most common surgery done in department of obstetrics and gynecology. It becomes more complicated in cases of high risk pregnancy like PIH, APH etc. Its rate is increasing day by day. Once a CS, always a CS, is questionable but being followed up at various set up due to various reasons. Today, one of the important indications of repeat CS is previous CS which increases the rate of CS in a particular set up and morbidities associated with multiple CS. According to ACOG guidelines, VBAC should be attempted to decrease the incidence of repeat CS and morbidity among them. This study was conducted to analyze the incidence of subsequent CS in previous one CS cases, demographic variables and feto-maternal outcome in previous CS patients.Methods: This was a retrospective observational study on previous CS patients, carried out in District hospital, Dumka, Jharkhand. The rates, demography and feto-maternal outcome among previous one CS patients were studied during 1 year duration and data was obtained from labor room and medical record department.Results: Out of 2947 deliveries, 63 patients had previous one cesarean section, the incidence being 2.13%. 39.7% deliver vaginally while 60.3% needed repeat cesarean section. Majority (95.2%) were in 21-30yrs age group, 76.2% were unbooked and 25.4% were tribal population. Maximum (79.4%) were gravid 2 and 93.7% were term. 93.7% had birth space >18 months. Out of 38 repeat cesarean section, 78.9% underwent emergency cesarean section. The most common indication being scar tenderness (39.5%) followed by CPD (15.8%). Intraoperatively, severe adhesions found in 15.8% cases, bladder adherence in 18.4% cases and 2.6% had adherent placenta. PPH occurred in 4.8% cases and blood transfusion or injectable iron therapy required in 25.4% cases. 4.7% had wound infection, 7.9% had prolong hospital stay and 22.2% cases required prolong foley’s catheterization. There was no maternal mortality. 95% babies born alive, 3.2% was stillbirth, 1.5% was IUD and the neonatal death rate was 3.2%.Conclusions: Previous cesarean section is one of the most important causes of CS in subsequent pregnancies, hence increase in the rates of CS and the morbidities associated with multiple CS among mothers. Thus the decision of CS in primigravida should be taken wisely and practice of CS on demand should be discouraged.

Maternal and perinatal outcomes in repeated cesarean section

Aim. To analyze the maternal and perinatal outcomes in repeated caesarean section. The first group included 50 laboring women who received combined endotracheal anesthesia for a repeat cesarean section. The second group included 50 laboring women who received spinal anesthesia during the operative delivery. The condition of 100 newborns born by repeated cesarean section was studied.Results. In postpartum period in the women of first group very often, develop endometritis (24%), in second group – 36%, hematometra in first group we see in 12%, in second – 26%. Tracheobronhitis occur in first group among 30%. Research of the condition and course of early neonatal period in newborns showed, that combined anesthesia initiates pathological course of this period. The main complications were asphyxia (28%), and neurological disorders (22%).Conclusions. Different types of analgesia initiate different types of complications in the postoperative period, but better neonatal outcomes with the use of regional anesthesia techniques qualify them as the anesthesia method of choice for repeat cesarean section.

“THE WAR WHEN YOU ALREADY HAVE A SCAR” -STUDY OF DIFFICULTIES IN EXTRACTION OF BABY IN PREVIOUS CESAREAN SECTION

Background:The study of intraoperative difculties in extraction of baby in previous cesarean section Method:This is a tertiary centre based prospective observational study conducted in the department of Obstetrics and Gynaecology, at our tertiary health Care hospital between the study period October 2018-september 2020.A total 1200 cases of patients with previous cesarean section were studied . They are divided into number of previous scar and the intraoperative surgical difculty encountered by the surgeon in delivering the baby based on the consequences of scar from previous cesarean section. Results: The incidence of repeat cesarean section being 9.4%, among which only of 38% cases were encountered with difculties in cesarean section by the surgeons in the institute. Among which 26.3% cases were encountered with Adhesions,4.2% with difculty in delivery of baby, 1.5% cases needed assistance by senior surgeon in delivering baby and 6% among that had poor perinatal outcome. Conclusions: The common clinical entity of “previous cesarean section” in subsequent pregnancies, giving a high risk pregnancy status to the reference pregnancy. The risks associated with repeat cesarean section can be reduced by many measures including-vigorous ANC surveillance to reduce the risk of primary CS, intervention by operative vaginal delivery whenever needed, giving trial of labor in cesarean section(TOLAC) with skilled monitoring, counselling of patients regarding perineal exercises in pregnancy. Most complications will be recognized at the time of operation and easily corrected either by the operating surgeon or by seeking assistance from other specialties

Early Childhood Outcomes Among Infants Born by Vaginal Birth After Cesarean and Repeat Cesarean Delivery in the Military Health System

ABSTRACT Objective This study examines whether children delivered by repeat cesarean section experience higher incidences of otitis media, respiratory infections, and allergic diseases than children delivered by vaginal birth after cesarean section (VBAC) in the Military Health System. Study Design This is a retrospective cohort study from the Military Health System Data Repository of women who underwent repeat cesarean section or VBAC between 2006 and 2012 and their offspring through 2014. Results About 11,659 infants with 2 years of follow-up were identified. Infants delivered by VBAC had lower odds of developing respiratory illness (P < .000), otitis media (P < .001), and allergies (P = .022) compared with infants born by repeat cesarean section. There were no differences in the development of food allergies. Conclusion Emerging data regarding early childhood health are additional factors that can influence the mother’s decision on mode of birth after a primary cesarean section.

Prevalence of Repeat Cesarean Section in a Tertiary Care Hospital

Introduction: Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. Methods: This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. Results: Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). Conclusions: The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.