SCARRED UTERUS: COMPLICATIONS IN THE SUBSEQUENT PREGNANCIES OF TWO OR MORE CAESAREAN SECTIONS AND THEIR SOCIAL IMPLICATIONS

The world is witnessing an increase in the rate of Caesarean sections for the last couple of decades, giving the women an obstetric status of 'previous Caesarean section.' While the crucial lifesaving role of Caesarean section in modern obstetrics is evident, the potential adverse effects of high Caesarean section rates are less expressed. In this descriptive observational study, we assessed the frequencies and variations seen in intraoperative surgical complications, post-operative complications and immediate fetal outcome in 100 patients with previous two or more Caesarean sections in a tertiary care hospital. The social implications behind third or higher order pregnancies have also been studied. The most common intraoperative complication encountered was intraabdominal adhesions (25%) followed by impending scar rupture (13%). Intra-abdominal adhesions were most commonly between anterior abdominal wall and anterior surface of uterus. Signicant blood loss was noted in 21% cases. The most common contraceptive used prior to the current pregnancy was barrier methods (75%) while 58% couples opted for tubal ligation along with the current Caesarean section. 6% couples did not opt for any contraception despite having multiple previous Caesarean sections. The risks associated with multiple repeat Caesarean sections are many, taking a toll on maternal health and fetal wellbeing. This study provides important information to counsel pregnant women with multiple previous Caesarean sections to know more about the complications associated with repeat emergency Caesarean section.