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ANNEXURE II
Women are almost three times more likely to have a caesarean birth now than they
were twenty years ago (Fran come et al, 1993) this rise is attributable to many factors,
vastly due to improved safety of the operation and better anesthetic techniques but
there were also fear of litigation (Savage and Fran come, 1993). 2 Prospective study was
made by Anuradha kumar et al, from Sept. 1993 to May 1994. 15.8% of patient had
elective and 84.2% had emergency caesarean section. The incidence of primary
caesarean including elective and emergency was 14.8% out of 1418 deliveries. 3
However Hall and bewley in 1999 stated that emergency cesarean delivery
was associated with an almost 9fold risk of maternal death compared with that of
vaginal delivery and elective cesarean section was associated with an almost 3fold
risk. Increase in rates of severe obstetrical complications was associated with rising
in cesarean delivery rate. The maternal morbidity rate was increased twofold with
cesarean delivery compared to vaginal delivery. All the morbidities and increased
recovery time resulted in twofold increase of cost for cesarean delivery compared
to vaginal delivery.5
The objective of this study is to compare the maternal morbidity during and
after primary cesarean section with that of repeat cesarean section
6.2 REVIEW OF LITERATURE:
The term Caesarean is for abdominal delivery of a child by cutting through the
abdominal wall and the uterus was perhaps derived from Lex regia which later
became known as Lex caesarica (Caesars law). Towards the end of eighteenth
century, it was performed in recently dead or moribund women to extract and save the
baby. In the nineteenth century, it was done on the living women with a reasonable
chance for the womens survival. The first recorded cesarean section on living women
was done in 1,500 AD, performed by a person of Swiss nationality, Jacob Nufer on his
wife. In U.K. the first recorded on living women was performed in Edinburgh by
Robert smith 1.
V. Kamala Jay Ram reported study in five year. Out of 16782 deliveries, the
caesarean rate was 16%, because of associated risk factor and late referrals. In this,
62.75% was Primary caesarean section and 37.25% was repeat caesarean, among the
Primary caesarean 91.4% were emergencies and 8.6% were elective cesarean section.4
Between 1989 and 1996 the total cesarean rate decreased as result of decrease in
primary and increase in rate of vaginal birth after cesarean(VBAC) but since 1996 the
rates of primary and repeat cesareans have increased.6
Anuradha Kumar et al, studied that hemorrhage was the most common
intraoperative complication observed in 10% of cases.3 Atonic PPH were seen in high
risk cases. Bladder injury and difficulty in approaching the lower uterine segment
occurred in cases of repeat sections.Intra operative hemorrhage is commonest in
elective cesarean due to adhesions from previous cesarean section.7
Women having their fourth or more cesarean delivery had a 9 to 30 fold increased
risk of placenta accreta and 4 to 15 fold higher risk of hystrectomy. 8 In cases of
placenta previa, the risk of placenta accreta was 40% for those having their third
cesarean and over 60% for fourth or greater ceasarean delivery.9
TYPE OF STUDY :
Randomized prospective clinical study of 100primary and 100repeat cesarean
section in term singleton pregnancies.
DURATION OF STUDY:
Statistical analysis will be done by using student t test and other relevant
statistical methods.
Study includes all women who will undergo cesarean section both primary and repeat
cesarean at the department of OBG, Navodaya medical college hospital and research
center, Raichur.
Inclusion Criteria:
1. All term singleton pregnant women with gestational age greater than or equal to
37 weeks are accepted for study.
Exclusion Criteria:
1. Multiple pregnancies
2. Cesarean section done before 37 weeks gestation.
Yes
7.4 Has ethical clearance been obtained from institution in case of 7.3?
Yes, ethical clearance has been taken from ethical clearance committee of the
institution.
8 REFERENCES
6)Martin J A, Hamilton BE, Sutton PD, et al. Births: final data for 2005. National
vital statistics reports, vol.56 no 6. Hyattsville (MA): National Center for Health
Statistics;2007.
8)Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. 2004 Multiple
cesarean section morbidity. Int J Gynaecol Obstet;87:227-32.
9. Signature of Candidates
10. Remarks of Guide THIS STUDY IS RECOMMENDED AS IT
DEALS WITH COMPLICATIONS
WHICH LEAD TO MATERNAL
MORBIDITY AND GIVES AN INSIGHT
OF WHETHER PRIMARY OR REPEAT
CESAREAN SECTION HAS LESS
MATERNAL MORBIDITY.
11.2 Signature
11.3 Co-guide
11.4 Signature
11.6 Signature
12.2
Signature