Intraoperative surgical difficulties encountered during repeat caesarean section in a tertiary care centre in Northeast India

Background: Caesarean section is the commonest obstetric operative procedure worldwide. The potential perioperative problems in repeat caesarean section include adhesions, increased blood loss, prolonged operative time, injuries to adjacent structures, hysterectomy etc. These increase with increase in caesarean section number.Methods: Hospital based observational study, conducted at Dept. of Obstetrics and Gynaecology, Assam Medical College, from July 2019 to June 2020 with the aim to study intraoperative difficulties encountered during repeat caesarean section. Cases were grouped into two main groups based on number of prior caesarean sections. A detailed history, clinical and intraoperative findings of all pregnant women undergoing repeat caesarean section were noted. Results were tabulated and analysed.Results: Out of 400 women with prior caesarean section who underwent repeat caesarean. 321 had 1 prior caesarean and rest had 2. Among the cases cephalopelvic disproportion was the commonest (43.25%) indication and obstructed labour was the least common (0.25%). Common complications were adhesions (38.25%), thinned lower uterine segment (27%), advance bladder (19.50%), uterine dehiscence (14.75%), excess blood loss (12.75%), extension of uterine incision (8.25%), uterine rupture (1%), placenta accrete (0.75%), and bladder injury (0.5%). Intraoperative complications like adhesions, uterine dehiscence, delivery and operating time were significantly higher in women with 2 prior caesarean section compared to 1 prior caesarean section (p<0.001).Conclusions: Women with caesarean scar are at high risk in subsequent pregnancies particularly in a country like India where antenatal care is often neglected. Best technique to reduce multiple potential complications of repeat caesarean section is to reduce the rates of primary and repeat caesarean sections whenever possible