Abstract

Background: Complications of higher order cesarean sections especially major degree placenta previa and placenta previa accrete are the biggest challenges obstetricians are facing worldwide. Maternal complications e.g. placenta previa/accreta, dense intra-abdominal adhesions and bladder injury increase as the number of repeat cesarean section increases.

Aim : To analyze maternal complications associated with higher order caesarean section.

Setting: Department of Gynecology and Obstetrics, Sir Ganga Ram hospital, Lahore.

Duration: 6 months (July to December 2017).

Sample size: 100 pregnant females with at least one previous cesarean section.

Sampling technique: Non probability consecutive sampling.

Methodology: This Analytical study was conducted on patients undergoing elective and emergency cesarean sections were included in the study and divided into two groups; lower order (3 or less than 3) and higher order (4 or more than 4) cesarean sections. Complications like formation of adhesions, placental abnormalities, scar rupture, emergency hysterectomy, bladder injury & admission to intensive care unit of both groups were recorded on a proforma & compared between the two groups.

Data Analysis: The data was analyzed through SPSS version 20. Student t test was used for analysis of quantitative data and chi square for qualitative data. The p-value of <0.05 was taken as statistically significant.

Results: Maternal complications like frequency of dense adhesions 49(98%) versus 42(84%), placenta previa 24(48%) versus zero (0%) and bladder injury 12(24%) versus 1(2%) remained significantly high (p-value <0.05) in study as compared to control group respectively.

Conclusions: Higher order cesarean are associated with significantly increased risk of maternal complications as compared to low order cesareans.

Key points: maternal morbidity, higher and lower order, cesarean section