Estimation of maternal and fetal morbidity in high order cesarean section in Zawia

Abstract

 To assess the maternal and neonatal risk associated with high order cesarean sections, a prospective study was carried out in Zawia hospital, maternity wards. The patient was interviewed in the labor word and performed case sheet filled with specific data. The outcome of 458 cases, 218 women undergoing cesarean section for the third time or more was compared with 240 women sectioned for the second time (P1c/s), the outcome measures were antenatal complication, maternal operative and postoperative morbidity and neonatal prematurity, Apgar scores and the need for intensive care. The antenatal complication is more in group of ≥ P2c/s, placenta previa 9 (3.7%) versus 3 (1.3%) and abruption 8 (3.3%) versus 1 (0.4%). Intraoperative complications found in 17.7% of the cases, 14.2% of the patients with P1c/s comparing with 20.8% among the cases with ≥ 2 Pc. Intra-peritoneal adhesions were more in women with ≥ P2c/s (10.8%) when compared with the women with the history of P1c/s (8.7%). The need for blood transfusion was 5.0% of women with history of ≥ P2c/s  compared with 4.1% for women with history of one previous section. The mean duration of operation for patients with P1c/s = 41.5 min and with P2 or more c/s = 47.8 min. Neonatal morbidity rate was 20.9%. There were an increased number of preterm babies in study group of ≥ 2 Pc/s.  It is concluded that high order repeat cesarean section carry risk of intraoperative and post operative complication in particularly, placenta previa and acreta and risk of blood transfusion and also neonatal morbidity is increased.