Habiba Akther1, Mirza Osman Beg2, Mahboba Akther3, Jakia jahan Chowdhury4
1. Associate Professor(cc), Department of Gynae and Obstetrics, North East Medical College, Sylhet.
2. Associate Professor(cc), Department of Orthopaedics, North East Medical College, Sylhet.
3. Consultant, Bahubol Upazilla Health Complex, Hobigonj
4. Assistant Professor, Department of Gynae and Obstetrics, North East Medical College, Sylhet.
Abstract
Caesarean section is one of the most commonly performed surgical procedures all over the world associated with high maternal and fetal morbidity and even mortality. Aims and objective of this study, to determine the fetomaternal outcomes in pregnancy with previous two or more caesarean sections. We previous performed an observational study over 9 months pragnent women with previous who has undergone two or more caesarean sections and fetomaternal outcomes were evaluated. Total 102 mothers had history of previous two or more caesarean sections out of which only 1 patient had previous three caesarean sections. Among them 92 2% cases were registered at antenatal clinic with three or more antenatal visits and 7.8% cases were unregistered. Among the mothers 68.6% patients underwent elective caesarean section while 31.4% underwent emergency caesarean section Placenta previa was encountered in 7.9% patients. The most common intraoperative complication was the presence of adhesions (23.5% cases) followed by haemorrhage (10.8%), thin lower uterine segment (LUS 2.9%), bladder injury(1.0%) and scar dehiscence (1.0%). Blood transfusion was needed in 14.7% cases, peripartum hysterectomy was done in 3.9% patients. Only 8(7.8%) babies were born with low birth weight(<2.5 kg), 54(52.9%) were male and 4(3.9%) babies had APGAR score <7 at 5th minute of birth and were subsequently admitted in NICU. Intraoperative complications and interventions were found significantly(P value: P£0.01) higher in the unregistered patients than in the registered ones and also in the patients with emergency CS than in those with elective CS. Fetomaternal complications are increased in multiple repeat caesarean sections. Risk reduction may be possible by managing patients in tertiary centres. Following strict indications in first CS, regular antenatal checkups and prior anticipation and preparedness for complications.
Key words: Multiple caesarean sections, Fetomaternal outcomes, pregnancy.