Maternal Morbidity in Primary Versus Repeat Cesarean Sections: A Prospective Comparative Study at a Tertiary Care Centre in India
Kalpana Vankayalapati *
BJ Medical College, Sassoon Hospital, Pune, Maharashtra, India.
Deepali Jadhav
BJ Medical College, Sassoon Hospital, Pune, Maharashtra, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Cesarean section is an essential obstetric intervention when medically indicated; however, repeat cesarean delivery may increase operative difficulty and maternal morbidity.
Aims: This study compared intra-operative and post-operative maternal morbidity between primary and repeat cesarean sections in a tertiary-care setting.
Methods: This hospital-based prospective comparative observational study included 220 pregnant women who underwent cesarean section. Group I comprised 120 women undergoing primary cesarean section, and Group II comprised 100 women undergoing repeat cesarean section. Demographic, obstetric, intra-operative, post-operative, and maternal morbidity variables were recorded using a predesigned proforma. Categorical variables were compared using the chi-square test or Fisher's exact test, and factors associated with repeat cesarean section were assessed using bivariate logistic regression.
Results: Of the 220 women included, 120 (54.5%) underwent primary cesarean section and 100 (45.5%) underwent repeat cesarean section. Repeat cesarean section was associated with higher intra-operative morbidity, including fused abdominal wall layers (16.0% vs 1.7%, p<0.001), intra-peritoneal adhesions (16.0% vs 0.8%, p<0.001), and uterine dehiscence (14.0% vs 0.0%, p<0.001). Wound infection was also more frequent in the repeat cesarean section group (11.0% vs 0.8%, p<0.001). Blood transfusion or blood units were required in 40 women overall (18.2%) and did not differ significantly between groups. Mean operating time was significantly longer in the repeat cesarean section group (49.61 +/- 8.75 min) than in the primary cesarean section group (45.21 +/- 8.31 min; p<0.001). Maternal age of 31-40 years and poor medical history were significantly associated with repeat cesarean section.
Conclusion: Repeat cesarean section was mainly associated with increased intra-operative adhesions, fused tissue planes, uterine dehiscence, wound infection, and longer operating time. Careful antenatal assessment, correction of anemia, senior surgical involvement, and prevention of avoidable primary cesarean section are essential to reduce repeat cesarean-related morbidity.
Keywords: Cesarean section, repeat cesarean section, maternal morbidity, intra-operative complications, adhesions, uterine dehiscence, blood transfusion