Abstract

Roll out of comprehensive national program directed towards maternal and neonatal health, change in mindset of health care providers from curative to preventive health service provision leads to prompt availability of referral services in last few years. Overall this changed trend have lead to increased prevalence of C section in India i.e. 17.2% (NFHS 4). This increased incidence is associated with increased incidences of multiple caesarean section. This life saving procedure have its own perils as multiple c section is associated with increased magnitude of maternal morbidity. This prospective study was conducted to study the various maternal morbidity associated with multiple c section in a tertiary care hospital in central India. Method: Prospective cross sectional study was conducted for 1 year from 1 march 2020 to 28 Feb 2021 at SSMC, Rewa, MP. Result: There were 100 cases of multiple c section meeting our inclusion and exclusion criteria in study period. Out of 100; 80 were previous 2 section and 20 were of previous 3 c section. In our study, 17% had bladder adhesions, 8% had bowel adhesions, 10% had atonic uterus, 4% had morbidly adherent placenta, 1% had scar rupture and 7% had scar dehiscence. Bladder adhesions, bowel adhesions, morbidly adherent placenta and scar dehiscence cases were significantly higher in three previous LSCS mothers in comparison to two previous LSCS mothers. Incidence of atonic PPH and scar rupture were higher in these multiple c section cases. These multiple c section cases were associated with increased chances of post-operative puerperal sepsis, wound infection, UTI and delayed suture removal. Conclusion: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries every effort should be done to reduce incidence of CDMR and c section done for ease of health care providers. Maximum trial of normal labour and decision of c section should be taken as per new ACOG guidelines.

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