“THE WAR WHEN YOU ALREADY HAVE A SCAR” -STUDY OF DIFFICULTIES IN EXTRACTION OF BABY IN PREVIOUS CESAREAN SECTION

Abstract

Background:The study of intraoperative dif\uf001culties in extraction of baby in previous cesarean section\nMethod:This is a tertiary centre based prospective observational study conducted in the department of Obstetrics and Gynaecology, at our tertiary\nhealth Care hospital between the study period October 2018-september 2020.A total 1200 cases of patients with previous cesarean section were\nstudied . They are divided into number of previous scar and the intraoperative surgical dif\uf001culty encountered by the surgeon in delivering the baby\nbased on the consequences of scar from previous cesarean section.\nResults: The incidence of repeat cesarean section being 9.4%, among which only of 38% cases were encountered with dif\uf001culties in cesarean\nsection by the surgeons in the institute. Among which 26.3% cases were encountered with Adhesions,4.2% with dif\uf001culty in delivery of baby,\n1.5% cases needed assistance by senior surgeon in delivering baby and 6% among that had poor perinatal outcome.\nConclusions: The common clinical entity of “previous cesarean section” in subsequent pregnancies, giving a high risk pregnancy status to the\nreference pregnancy. The risks associated with repeat cesarean section can be reduced by many measures including-vigorous ANC surveillance to\nreduce the risk of primary CS, intervention by operative vaginal delivery whenever needed, giving trial of labor in cesarean section(TOLAC) with\nskilled monitoring, counselling of patients regarding perineal exercises in pregnancy. Most complications will be recognized at the time of\noperation and easily corrected either by the operating surgeon or by seeking assistance from other specialties