Maternal and Perinatal Outcome of Repeat Caesarean Sections in Shaheed Suhrawardy Medical College Hospital

Abstract

Background: The rising rates of caesarean sections globally have led to increased focus on the risks associated with repeat caesarean sections (RCS), including maternal and perinatal complications. In resource-limited settings like Shaheed Suhrawardy Medical College Hospital, understanding the outcomes of RCS is crucial for improving clinical management and reducing morbidity. This study evaluates RCS's maternal and neonatal outcomes to inform better healthcare practices. Purpose: This study aims to evaluate the maternal and perinatal outcomes associated with repeat caesarean sections (RCS), focusing on incidence, patient demographics, causes, mode of delivery, and preoperative challenges, as well as associated morbidity and mortality. Methods: This prospective, cross-sectional, analytic study was conducted at Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, from July to December 2011. A total of 100 cases with gestational ages between 28 and 42 weeks and a history of one or more previous caesarean sections were selected. Data were analyzed regarding demographic profiles, clinical indications, and outcomes. Results: Among 1260 deliveries during the study period, 57.14% were caesarean sections, with a primary caesarean rate of 60% and repeat caesarean rate of 40%. The most common age group undergoing RCS was 20–30 years (52%), followed by 31–35 years (35%). Multigravida women accounted for 80% of RCS cases. The leading indications for emergency RCS included previous caesarean sections with fetal distress, cephalopelvic disproportion (CPD), malpresentation, placenta praevia, and suspected impending uterine rupture. Elective RCS accounted for 70% of cases, while emergency RCS made up 25%. Scar rupture necessitated laparotomy in 2% of cases, and 3% of patients achieved vaginal delivery. Maternal morbidity was observed in 15% of cases, although no maternal deaths occurred. For neonatal outcomes, 95% of neonates survived, 2% were fresh stillbirths, and 3% experienced early neonatal death. Conclusion: The study highlights a high caesarean section rate at ShSMCH, with previous caesarean history being the most frequent indication. RCS was associated with significant antepartum, peripartum, and postpartum complications, particularly in cases with a history of two or more prior caesarean sections. Enhanced perinatal monitoring and surgical preparedness are essential to optimize outcomes for both mothers and neonates.