A Cross-sectional Study for the Impact of Primary Caesarean Section on Future Pregnancy Outcome at Rural Based Tertiary Care Centre in Gujarat, India

Background: The increasing trend of caesarean sections (CS) has raised significant concerns regarding the health and safety of both mothers and babies. Rising maternal age, obesity, diabetes, and other pre-existing health conditions contribute to more complex pregnancies, making CS a more common recommendation. However, CS face higher risks in future pregnancies, such as intraabdominal adhesions, uterine rupture, placenta previa, and placental accreta, potentially leading to severe bleeding. To address this trend, strategies to promote vaginal births after caesarean and minimizing unnecessary interventions, could help reduce the risks associated with overuse of CS.

Aim: To investigate the maternal and foetal outcomes of caesarean, including the prevalence of adhesions in secondary CS & the comparison of emergency versus elective procedures.

Study Design: Retrospective cross-sectional study.

Place: Shree Krishna Hospital, Karamsad, Anand, Gujarat.

Duration of Study: March 2023 to December 2023.

Methodology: This study analysed data from 811 patients who underwent caesarean delivery, of which 501 were CSs. We examined indications, operative risk factors, intraoperative findings, postoperative management, complications, and neonatal outcomes. Data were compared between primary and secondary CSs, as well as elective and emergency CSs, to identify significant differences in maternal and neonatal outcomes. Statistical analysis was performed to evaluate the findings. Detailed data were collected using Epi Info 7.2.5.0.

Results: Of 811 deliveries, 61.77% were CSs, with 43.71% being secondary. While primary and secondary CS did not differ significantly in ICU admission, PCV, prolonged antibiotics, or total hospital stay, CSs were associated with prolonged catheterization. Multiple previous CS increased the incidence of organ adhesions & scar dehiscence. Obesity was linked to denser adhesions & poorer fetal-maternal outcomes. Emergency CSs exhibited significantly higher rates of ICU admission, PCV requirement, antibiotic use, and longer hospital stays compared to elective procedures. Of 501 new-borns, 35.92% required NICU admission, with a higher rate after emergency CS. Emergency CS was also associated with increased fetal complications such as RDS, TTN, birth asphyxia, sepsis, and antibiotic use compared to elective procedures. Primary CS also showed more fetal complications than secondary CS.

Conclusion: Secondary CS posed significant maternal challenges, while fetal outcomes are more favourable in secondary CSs. The risk of adhesions increased with subsequent CSs. Emergency CS was associated with higher rates of maternal & foetal complications.