TO STUDY THE INCIDENCE AND TYPE OF SURGICAL DIFFICULTIES ENCOUNTERED IN REPEAT CESAREAN SECTION IN COMPARISON WITH THE PRIMARY CESAREAN SECTIONS.

Abstract

Cesarean section is the most common surgery performed with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Previous C-section delivery was a major indication for a repeat C-section delivery. The present study aims knowing the intra-operative difficulties encountered by an obstetrician, in this highly evolved surgical procedure called C-section especially in a repeat C-section. It was a Prospective observational study conducted on 60 cases of repeat cesarean section in c/o previous one cesarean section. Difficulties encountered while operating on cases of previous one cesarean section were noted. The intraoperative complications were compared with respect to adhesions (peritoneal, bladder, bowel, omental etc), blood loss, extension of tears over uterus, bladder injury, scar dehiscence, uterine rupture, need for hysterectomy. In present study, following intraoperative morbidities were encountered- adhesions 38.33%, advanced bladder 20%, excess blood loss 10%, placenta accrete was found in 1.67%,thinned out scar seen in 5% . Bladder injury seen in 1.67% patients. No cases of uterine rupture & bowel injury were noted. None of the patient needs caesarean hysterectomy. In modern obstetric practice, objective is safe motherhood and healthy baby by proper management. From present study, it can be concluded that repeat caesarean sections in c/o previous one cesarean section are associated with increased complications which lead to increased maternal morbidity

Keywords:  Primary Cesarean section , Repeat Cesarean section ,  Caesarean Section Difficulties.