M. Vijayasree1 , T. Indira2
BACKGROUND Caesarean section is one of the most commonly performed major surgical procedures worldwide, with an estimated 18.5 million cases performed annually. In the present-day scenario, multiparas are considered to be at increased risk for anaemia, malpresentations, haemorrhage, cephalopelvic disproportions, uterine rupture, and complications associated with chronic medical disorders like hypertension and diabetes. Some of them may land up in caesarean section owing to the associated risk factors. We wanted to study the prevalence and indications of primary caesarean section in multigravida and evaluate the maternal and foetal outcome following caesarean delivery. METHODS It was a cross sectional study conducted among 100 women of primary caesarean section among multigravida who had a previous normal vaginal delivery, for a period of 2 years in the Department of Obstetrics and Gynaecology at Mamata Medical College. Various indications for caesarean section were studied and maternal and perinatal outcomes were analysed. RESULTS The incidence of primary caesarean section in multigravida among total number of deliveries was 6% and among all caesarean sections was 14%. Among 100 multi-gravida, 32% were booked and 68% were unbooked women. Most of them were in the age group of 25 to 29 years (42%), followed by 20 to 24 years (30%). Remaining were more than 30 years old (28%). Most of them were gravida 2 (82%) followed by gravida 3 in 14% of cases. 4% of them were gravida 4. Majority of them had anaemia (38%). Medical complications like gestational diabetes were seen in 12% and pre-eclampsia was present in 14%. Recurrent pregnancy loss was found in 22%. 10% had post-dated pregnancy. Elective LSCS was done in 12% and Emergency LSCS was done in 88% of the women. Foetal distress was the indication in 28% of the women followed by severe oligohydramnios in 14% and malpresentation in 12%. There were no complications in 38% of the women and the most common post-operative complication was puerperal pyrexia 14%. Most of the babies delivered were of 3 Kg to 4 Kg birth weight (56%). CONCLUSIONS Many unforeseen complications like prolonged labour, obstructed labour, malpresentations can occur in parous women who had previous vaginal delivery that may require emergency caesarean section. Careful assessment of these patients during antenatal and intranatal period can improve maternal and perinatal outcome.
