Challenges of Repeat Cesarean Sections: An Analysis of Intraoperative Complications in a Tertiary Care Hospital, Salem

Abstract

Introduction: In the world, caesarean sections are the most prevalent obstetric surgical procedures. Potential perioperative complications after a repeat caesarean section can include adhesions, higher blood loss, extended surgery, damage to nearby structures, hysterectomy, and more. These rise in tandem with the number of caesarean sections.

Aim& objectives: To avert complications, to evaluate the intraoperative surgical challenges in patients with one or more previous cesarean sections and to predict and handle surgical difficulties that may arise during a repeated cesarean section

Material & methods: Fifty pregnant patients with a history of prior caesarean sections participated in this hospital-based trial. These patients were from Vinayaka Mission's Kirupananda Variyar Medical College and Hospital in Salem, from October 2022 to March 2024 (18 months) in the obstetrics and gynaecology department. The patient was chosen based on inclusion and exclusion criteria after giving their informed consent in order to evaluate the different intraoperative surgical problems and challenges that arise during recurrent caesarean sections. Every pregnant woman undergoing a repeat caesarean surgery had her complete medical history, clinical results, and intraoperative observations documented. The findings were tallied and examined.

Results:

The study analyzed 50 women with previous caesarean sections who underwent repeat caesareans. 60% were from the G2 group, with a decrease in the proportion of women with previous cesarean sections as gravidity increases(p = 0.0059). The most common indications were previous LSCS with pain(61%). Adhesions were present in 36% patients, with severe adhesion scores of 22%. Most deliveries occurred within the first 5 minutes, and the duration of surgery varies by type and Number of previous cesarean sections(P<0.0007). Common complications included adhesions (36%), scar issues(38%), emergency hysterectomy(6%), placenta issues(8%), blood transfusions(14%) and rupture uterus(2%).

Conclusion: Recurring pregnancies after a cesarean scar puts a woman at great danger, especially in a nation like India where prenatal care is frequently disregarded. When it is feasible, lowering the rates of initial and repeat cesarean sections is the best way to minimize the numerous potential consequences of such procedures.