An Observational Study of Intraoperative Complications during Lower Segment Caesarean Section at a Tertiary Care Institute

Abstract Introduction: Cesarean section is most common obstetric surgery performed worldwide. Though the caesarean section is a safe procedure still complications that have adverse consequences for the mortality and morbidity of both the mother and the newborn are well documented in the literature. So this study was done to observe various intraoperative complications encountered during lower segment caesarean section. Method: This observational study was conducted at a tertiary care institute of Rajasthan over a period of 12 months. 450 pregnant patients undergoing caesarean section were studied in terms of intraoperative complications during lower segment caesarean section. Data were studied and statistically analysed. Results: Repeat CS (38.4%) was the most frequent indication of the CS followed by foetal distress (12.7%) and on maternal request (9.1%). Most common complications observed were intraperitoneal adhesions ranging from flimsy adhesion (11.8%) to dense adhesion (3.6%), extension of uterine angle (9.8%), difficulty in delivering the foetal head (7.3%), traumatic PPH (8.2%) and atonic PPH (6.9%). Most common anaesthesia related complications observed was intraoperative hypotension (14.9%) followed by spinal headache (9.3%), The complication rate increases with increase in number of CS. Risk of intra-peritoneal adhesions, extension of uterine angle, PPH, scar dehiscence and bladder injury were significantly more in women with previous 2 or more CS than primary CS (p --<0.00001 for each). Conclusion: Best technique to reduce multiple potential complications of repeat caesarean section is to reduce the rates of primary and repeat caesarean sections whenever possible. Women should be counselled and whenever possible VBAC should be encouraged.