Lower Segment Cesarean Section (Lscs);

Abstract

Introduction: Caesarean section is one of the commonly performed surgical procedures in obstetric and is certainly one ofthe oldest operations in surgery. Recently there has been a dramatic rise in the caesarean section rate world wide especially in thedeveloped countries. As primary caesarean deliveries contributed most to the overall caesarean section rate (CSR). So this is clear thatprimary caesarean section is an important target for reduction because it leads to an increased risk for repeat caesarean delivery.Objectives: To have an overview of fetomaternal indications for LSCS at a teaching hospital And to review intra-operative and postoperativecomplications of LSCS at tertiary care centre. Material And Methods: All caesarean sections performed at Obstetrics andGynecology Unit Independent University Hospital Faisalabad from January 2009 to December 2010 were reviewed. Information wasobtained from operation theater and labor ward records. Results: During the study period 100 patients undergone caesarean section. Outof 100 patients, 58(58%) had emergency and 42(42%) had elective caesarean section. The leading maternal indications were previouscaesarean section 34 (34%), severe pre- eclampsia 6(6%),post date& failed induction of labor6 (6%), placenta previa 6(6%), and failureof progression of labor 5(5%), PROM3(3%), Pre-PROM3(3%)and cephalopelvic disproportion2 (2%).Major fetal indications include fetaldistress9 (9%), malpresentation 6(6%), cord prolapse 3(3%),IUGR 5(5%) and pregnancy complicated by multiple fetuses 7 (7%). Intraoperativesurgical and anesthetic complications were observed in very few patients. Nine babies had perinatal deaths in this study, 8belonged to emergency and only one baby died in elective group due to aspiration pneumonia. Conclusions: Majority of cesarean sectionare done in emergency situations and previous CS is the most frequent indication of cesarean section. The most effective mean to controlCS is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous Csection,selective vaginal breech delivery and regular audit of C-section as well as early detection of at risk cases and proper referral intime is the key factor in decreasing the cesarean section rate and complications.

Factors associated with emergency caesarean section delivery during term induction of labour: A case-control study

“…Analyzing the common indications for LSCS in our institute, the most common indication was previous LSCS (42.52%). Most clinical audits and studies done previously also showed an almost similar result [16,20,21] . Although previous LSCS without any obstetric complication is not an indication that supports a repeat LSCS, changes in the maternal and physician profile would have contributed to this increased rate.…”

“…The overall Cesarean rate in India was found to be around 17%, and the rate of LSCS was found to be increasing from 8.5% to 17.2% over a period of 10 years from 2005 to 2015. [20] The study from Chennai, which was conducted over a period of 2 years, showed a CS rate of 47% in the private sector [17] . The Cesarean section, when compared showed that the rate was more in the private sector (54%) than in the public sector (24%) [18] .…”

Labour outcome in primigravida who have crossed the alert and action lines on partogram

“…The guidelines are unclear on other medical conditions such as elevated maternal BMI, foetal macrosomia, GDM and twin pregnancies. It should be noted that the underlying medical conditions such as intrahepatic cholestasis of pregnancy, intrauterine growth restriction [10] , oligohydramnios and chorioamnionitis [11] , can be associated with increased rate of LSCS. Augmentation of labour was required in 31 mothers at 67.39% who crossed the alert line whereas it was needed in 12 mothers at 63.16% who crossed the action line.…”