Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.

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Background: Preeclampsia is associated with higher prevalence of abnormal global left ventricular function. So, present study was designed to compare these changes in normal and preeclamptic pregnancies using echocardiography.Methods: In present study, 25 patients with pre-eclampsia with singleton pregnancy between 20-30 years (study group) were compared with 25 age matched healthy pregnant women (control group). They were non-invasively analyzed for cardiovascular hemodynamics using echocardiography. The data was analyzed using student's t-test. P value <0.05 was considered to be significant. Results: Mean stroke volume in pre-eclampsia group was 72.4±5.1 ml v/s 67.7±5.6 ml in control group and the difference was statistically significant. Mean Cardiac output in preeclampsia group was64.2±3.4 lit/min v/s 5.69±0.47 lit/min in control group which is statistically significant. Mean Systemic vascular resistance (dyne.sec cm-5) in pre-eclampsia group was 1468.22±5.7 v/s 957.7±131 in control group which is statistically significant. Mean Ejection fraction (%) in pre-eclampsia group was 68.31±5.1 v/s 66.54±4.7 in control group which is statistically significant.Conclusions: Doppler echocardiography provides an excellent non-invasive method for evaluation of hemodynamic changes during pregnancy. Therefore if it is introduced into antenatal protocol, could help to identify subset of pre-eclamptic women who are at high risk to developing complications and thereby can do early intervention.