DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162136

Study of placentation and maternal and fetal outcomes in cases of 2 or more caesarean sections

Supriya Poonia, Meena Naresh Satia, Nidhi Bang

Abstract


Background: The CS epidemic is a reason for immediate concern and there is increase in repeat CS as well these days. The secondary increase in repeat CS delivery has been associated with increase in CS complications particularly increase in complications associated with abnormal placentation.

Methods: It is a Prospective observational study which was conducted at a tertiary care centre over a period of 18 months with a sample size of 60 patients. Patients with two or more previous CS irrespective of parity index, gestational age, previous vaginal delivery or vaginal birth after CS, associated medical or surgical problems were included in the study. Intra-partum, postpartum complications, abnormal placentation, maternal and perinatal outcomes associated with previous 2 CS were studied. Any case less than 2 CS were excluded.

Results: In this study, radiologically, 50 patients had no abnormality. 7 patients had placenta previa, 2 patients had placenta percreta and 1 patient had placenta previa with placenta accreta. These included abnormal placentation diagnosed radiologically by ultrasonography, colour Doppler or MRI. Intra-operatively, 49 patients had normal placentation. 6 patients had placenta previa without any evidence of placental adherence, 3 patients were placenta percreta. 1 patient had placenta previa with placenta percreta and 1 had placenta previa with placenta increta. Statistically significant differences p <.05 was observed in group of normal and abnormal placentation, with respect to type of anesthesia spinal/GA, uterine incision(pfannensteil versus midline and classical), bladder injury, intraoperative blood loss, uterine and internal iliac artery ligation, obstetric hysterectomy, placenta kept in situ, surgical site infections, neonatal resuscitation required and NICU admissions.

Conclusions: The incidences of abnormal placentation have increased with the rise in previous two CS Also the maternal and perinatal morbidity and mortality increases with history of previous two CS.

Keywords


Placentation, Previous two CS, Maternal and perinatal complications

Full Text:

PDF

References


Chhabra S, Arora G. Delivery in women with previous Caesarean section. J Obstet Gynecol India. 2006;56(4):304-7.

Serena WU, Kocherginsky M, Judith U, Hibbard MD. Abnormal placentation: twenty year analysis. ACOG. 2005;192:1458-61.

Usta IM, Hobeika EM, Abu- Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. 2005;193(3pt2):1045.

Sobande A, Eskandar M. Multiple repeat caesarean sections: complications and outcomes. Canada JOGC. 2006;28(3):193-7.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al: Maternal morbidity associated with multiple Caesarean deliveries. Obstet Gynecol. 2006;207:1226.

Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more? RCOG. 2004;111:1090-4.

Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201:56e1-6.

Nisenbalt V, Barak S, Griness OB, Degani S, Ohel G, Gonen R, et al. Maternal complications associated with multiple caesarean deliveries. Obstet Gynecol. 2006;108:21-6.

Cook J, Javis S, Knight M, Dhanjal MK. Multiple repeats caesarean sectionin the UK: incidence and consequences to the mother and child. A national prospective, cohort study. BJOG. 2013;120(1):85-91.

Sentilhes L, Ambroselli C, Kayem G. Maternal outcome after conservative treatment of placenta accreta. Obstetrics and Gynecology. 2010;115(3):526-34.

Hundley AF, Lee P. Managing placenta accreta. OBG management. 2002;8:18-33.

Macones GA, Cahil A, Pare E, Stamilio DM, Ratcliffe S, Stevens E, et al. Obstetrics outcomes in women with two prior caesarean deliveries: Is vaginal birth after caesarean delivery a viable option? Am J Obstet Gynecol. 2005;192:1223-9.

Cahill AG, Tuuli M, Odibo AO, Stamilio DM, Macones DA. Vaginal birth after caesarean for women with three or more prior caesareans: assessing safety and success. BJOG. 2009;117:422-8.