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JOURNAL OF COMMUNITY MEDICINE |
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INDIAN ASSOCIATION OF PREVENTIVE AND SOCIAL MEDICINE ORISSA CHAPTER |
L. Patnaik, D.S. Malini, R.M. Tripathy, T. Sahu |
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Introduction Caesarean section (C.S.) has become an increasingly common method of delivery worldwide, also increasing in developing countries. C.S. is an operative procedure where fetuses are delivered through an incision on the abdominal and uterine walls1. Pregnancy with history of previous Caesarean section is quite prevalent in present day obstetric practice. Recurrent C.S., scar rupture, hysterectomy and maternal and fetal deaths are some of the future important risks. Previous caesarean section increases the risk of multiple placental abnormalities like placental abruption, placenta previa, and adherent placentation in subsequent pregnancies2. These mothers require special attention during the antenatal, intranatal and postnatal periods as these are regarded as high risk pregnancies. So the present study was undertaken with objectives to assess the indications of present C.S. and Outcome of pregnancy in the present and previous caesarean section.
Material and methods The study was carried out in Obstetric and Gynecology ward of MKCG Medical College Hospital of Brahmapur for a period of three months (May –July 2005). All the antenatal mothers admitted during the study period were assessed and followed up till delivery. A total of 60 mothers were taken as study subjects. Their detailed history about the previous pregnancy and present pregnancy were taken and the present mode of delivery, indications of C.S. etc. were noted with pre-tested and scientifically designed schedules. The data collected were compiled and analyzed in the Dep’t of Community Medicine, M KCG Medical College, Brahmapur .
Results It was observed that maximum number of antenatal mothers with history of previous C.S. were in the age group of 20 – 24 years (35%) followed by 25-29 years (26.6%)and 30-34 years (18.3%), indicating an inverse relationship of age with number of caesarian sections. Out of 60 mothers, 63.3% were having 1 living child followed by 18.3% having 2 living children and 8.3% mothers were having 3 and 3% had >4 living children. Seven per cent mothers had no living children.
Table I: Distribution of pregnant mothers as per No. of previous C.S. (n=60)
Table I shows that most of the mothers (83.4%) had history of one caesarean section and only 3.3% mothers had undergone c.s. more than two times. Table II: Indications of C.S. in present delivery (n=55)
. Out of 60 mothers 55(91-6%) delivered babies through Caesarian Section. The indications of present C.S. were contracted pelvis in majority (73.3%) cases followed by post dated cases (7.2%) placenta praevia and PIH each 5.4% and eclampsia in 3.6% cases. Another 5.4% mothers were operated for other indications. Out of 60 mothers, 88.5% mothers had live babies in the last pregnancy and 11.5% had dead babies. In present delivery, 96.6% mothers delivered live babies. 5% mothers suffered from postpartum hemorrhage and 3.3% suffered from urinary tract infection. It was found that 60% of the mothers opted for permanent family planning methods after the present child birth.
Discussion It was observed that 41.6% of the study population was in the age group of
Most of the study population (63.3%) had 1 living child. Majority of the study population (83.3%) had undergone one C.S. previously. It may be due to 68% were in less than 30 years of age and operative procedure increases fear for more number of child birth and repeat CS. It was seen that 11.5% mothers had dead babies which may be attributed to minimum care in antenatal period, delay in referral or delay in admission to this hospital.
The indications of present C.S. were contracted pelvis in majority (73.3%) followed by post dated cases (7.2%), placenta praevia (5.4%), PIH (5.4%). In a study by Mesleh RA, Al Naim M, Krimly A, they observed that incidence of placenta praevia increases in mothers with more no. of previous caesarian sections3. Postpartum hemorrhage was detected in 5% cases, UTI and fever was detected in 3.3% cases. In the study by Van Ham et al, overall postoperative complications-major (pelvic infection, sepsis, deep vein thrombosis etc.) and minor (fever, urinary infection, wound sepsis, etc.) occurred in 35.7% of cases4. It was found that 60% of the mothers opted for permanent family planning methods after the present child birth.
Conclusion: The indications of present C.S. were contracted pelvis in majority (73.3%) followed by post dated cases (7.2%). The present mode of delivery was C.S. in 91.6% mothers. In present delivery, 96.6% mothers delivered live babies and thus the outcome was better. The pregnant mothers with previous C.S. should be more cautious during antenatal, intranatal, postnatal period for rendering health services. They should be given more attention by health professionals.
References D.C. Dutta, Text book of Obstetrics, New Central book agency (P) ltd., Calcutta, Fourth edition, 1998. Zelop C, Heffner LJ. The downside of cesarean delivery: short and long term complications. Clin Obstet Gynecol 2004; 47:386-93. Mesleh RA, Al Naim M, Krimly A, Pregnancy outcome of patients with previous four or more caesarean sections. J Obstet Gynaecol, 2001; 21(4):355-7. van Ham M, van Dongen P, Mulder J. Maternal consequences of cesarean section: a retrospective study of intraoperative and postoperative maternal complications of cesarean section during a 10 year period. Eur J Obstet Gynecol Reprod Biol 1997; 74:1-6. |
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A STUDY ON OUTCOME OF PREGNANCY IN MOTHERS HAVING PREVIOUS CAESARIAN SECTION |
