Study of primary caesarean section in multigravida

Aims: To know the incidence, indication and maternal and perinatal outcome of primary caesarean section in multigravida. To know the incidence and indications of primary caesarean section in multigravida. Materials and Methods: It is a prospective study of over 196 cases of caesarean section done for the first time in multigravida for a period of 2 years . For all the cases, blood was sent for basic investigations like Hb, blood grouping and typing, total count, differential count, urine examination. Special investigations like LFT, RFT done when required and for placental localization, abruption. Intrapartum cardiotocography done in cases where it was required. Results: This is a prospective study undertaken to analyze 196 cases of caesareansection done for first time in multigravidae during the study period of teo years. In Incidence of cesarean section, There were 6580 deliveries during this period around 1932 cesarean sections were done, which represented 29.3% of all deliveries. Incidence of primary cesarean section in parous women is 3% of all deliveries.. Status of booked / unbooked cases, Only 31.2% parous women had regular antenatal checkup and 68.8% did not receive any antenatal care. cases in multigravida women who underwent primary caesarean were ,the number of cases which was referred to us was 84 (42.86%), number of cases which were received directly was 96 (48.98%) and the number of cases which was already admitted in the ward were 16 (08.16%). Among the various maternal indications for caesarean section, malpresentations accounted for 23.4%,followed by antepartum hemorrhage (16.8 %), fetal indications (15.3%), medical disorders 16.5% and cephalopelvic disproportion 15.8%. Failed induction accounted for 11.7%. Among various fetal indications, fetal distress accounted for 7.6% and3.7% cases, the non stress test was non reactive. Gynaecological disorders in multigravida women who underwent primary caesarean were total 32 parous women had antenatal complications (16.3%). 126 patients had mild anemia, incidence coming upto 64.2%, 4 patients had severe nutritional anemia with hemoglobin less than 7 grams/dl, and they required blood transfusion before surgery5 patients had Antepartum eclampsia, 2 had chronic hypertension, 2 had Gestational diabetes. Conclusion: From the above study it is very clear that, many unforeseen complications occur in woman who previously had a normal vaginal delivery. . Though vaginal delivery is always safer than caesarean section, difficult vaginal delivery and obstructed labour carries more morbidity and perinatal mortality when compared to elective caesarean section.