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Background: Cesarean section is the commonest obstetric procedure done worldwide. Incidence of cesarean section is increasing giving it a term “repeat cesarean section”. Repeat cesarean section makes future obstetrics performances and abdominal exploration risky. After any Laparotomy it is fairly common to develop scar tissue, or adhesion. The scarring and adhesion formation is known to increase the major complications rate from 4.3% to 12.5% depending on the number of previous section. Intra peritoneal adhesions have an incidence of 5.5% to 42.5%. Methods: An observational prospective study was conducted in Obstetrics and gynecology department of Era’s Lucknow Medical College, Lucknow. Total 80 cases of repeat cesarean sections were included. The case histories and intra operative findings were recorded. Results: Intra peritoneal adhesions of varied types were seen in majority of cases, out of which the most commonly seen adhesion was between parietal peritoneum and anterior surface of uterus 24(30%) and adhesion between bladder and uterus 24(30%). Conclusions: Chances of developing adhesions increases with each cesarean section, which leads to increase in morbidity of women. Thus cases of previous cesarean section should be educated about routine antenatal care.

Background: Objective of current study was to study the outcome of trial of vaginal birth after Previous Cesarean Section (PCS) and indications for emergency repeat cesarean section at teaching hospitals in India. Methods: Prospective data was recorded on management practices, associated complications and mortality for a period of 8 months in 2005-2006 at 30 medical colleges/teaching hospitals for delivery. Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824) cesarean section and (10.1%) (n=15664) were the number of previous cesarean section. In 84% (n=13151) had repeat cesarean delivery and 2513 (16%) delivered vaginally. A trial of labor was planned in 4035 (25.8%) women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7%) delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%), foetal distress (25.8%), severe PIH/eclampsia (5.0%), previous 2 CS (0.7%), APH (1.4%) and others (2.7%). In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice.

Background: As cesarean birth rates continue to rise, more women are faced with the choice of planning a vaginal delivery or a repeat cesarean section after a previous cesarean section. The objective of this prospective study was to study the morbidities and mortality of women attempting a trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (El-RCS).Methods: Prospective data was recorded on management practices, associated complications and morbidity & mortality for a period of 8 months on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/ teaching hospitals for delivery.Results: A trial of labor was planned in 25.8% (4035) women and 34.5% (5399) women underwent elective repeat cesarean section and rest had emergency repeat cesarean section. Overall maternal morbidity due to any cause was 20.7% among El-RCS as compared to 14.2% in TOLAC which was statistically significant (OR: 1.57, CI: 1.41-1.76, P=0.00). Blood loss of more than 1000ml was around 8.0% among TOLAC where as in El-RCS it was 8.8% (OR: 0.89, CI: 0.77-1.94, p=0.14 not statistically significant). Blood transfusion was given in 3.7% in TOLAC where as in El-RCS it was given in 6.5% (OR: 0.56, CI: 0.45-0.68, p=0.00 highly significant). Complication like dehiscence of scar was similar in both groups. Post-operative complication were seen in 2.8% cases in TOLAC where as in El-RCS it was 5.8% (OR: 0.47, CI: 0.38-0.59, p=0.00 highly significant). Uterine rupture was 0.3% in TOLAC where as in El-RCS it was 0.7% (OR: 0.43, CI: 0.21-0.87, p=0.009 statistically significant). Maternal mortality was reported in 0.2% cases of TOLAC as compared to 0.1% cases in El-RCS (p=0.17) which was not statistically significant.Conclusions: Maternal morbidity was found to be more in elective repeat cesarean section than trial of labor after cesarean section.

Background: Cesarean section has become more prevalent over the years due to various factors and is exceeding the tolerable limit specified by WHO. The objective of this study was to analyze cesarean section rates in our department and to identify the factors that contributed to rising cesarean section rate considering both institutional aspects as well as socioeconomic causes.Methods: It was a retrospective study conducted between May 2015 to April 2016 and included all pregnant patients booked in antenatal clinic and unbooked patients admitted in early labour in whom cesarean section was conducted later along with cases coming in emergency for which cesarean section was indicated. Data was collected and categorized on the basis of age, parity, socioeconomic status, education and according to Robson’s ten group classification.Results: The cesarean section rate was found to be 33.2% in our study. The most common indication was repeat cesarean section, fetal distress, and breech presentation. Robson’s group1 had maximum cesarean rates followed by group 5, 6 and 3.Conclusions: Tertiary care centers cannot be expected to have a similar rate as primary and secondary ones due to high number of complex cases referred to them. Though effort should be made to keep the cesarean rate at a low level as suggested by WHO but denying it for an indicated case just to adhere to keep low rate jeopardizes maternal and fetal health. Hence no definitive guidelines can be followed and a very judicious approach is needed.