Intraoperative difficulties and challenges in 261 repeat caesarean section a rural hospital experience in Pondicherry
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 9
Abstract
The objective of the study is to analyse intraoperative difficulties encountered and challenges faced in repeat C sections. Retrospective analysis was done on medical records from 2008-2010, on 261 repeat caesarian sections done in SMVMCH, a rural referral hospital. Incidence of primary section in our study is 43.96 % and repeat section 21.85%. Referral 55.6%. Previous one section women were 70%. All had non closure of parietal peritoneum and one layer closure of uterus during previous section. There was difficulty in entering the peritoneal cavity in 136 (52.1%) women due to adhesions in 63, ventrofixation of uterus to abdominal wall 24, and cicaterised RPM scar in 49. Lower segment was inaccessible in 79 (32.6%) due to adherent bladder 37, adherent rectus muscle 6, dense adhesions in 36. Six women needed classical section, bladder injury repair 9, rent repair of dehiscent scar 41 (15.77%). Four had caesarean hysterectomy (1.05%). Relaparotomy was done for intractable intra abdominal bleeding needing uterine artery ligation in 2 post caesarean women and internal iliac artery ligation in one post caesarean hysterectomy vault bleeding. We did not have any mortality.
Authors and Affiliations
Wills G Sheelaa, N Fatima Shanthini
Keywords
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