STUDY OF THE PROPORTION AND VARIOUS INDICATIONS ASSOCIATED WITH PRIMARY CESAREAN SECTION IN MULTIPAROUS WOMEN IN TERITARY CARE HOSPITAL IN WESTERN MAHARASTRA

Background : World wide raise in cesarean section rate in the last three decades has been the cause of alarm and need for study in depth .cesarean section has been one of the most commonly performed surgical procedures . Primary caesarean section in the multipara means first caesarean section done in the patients who had previously delivered vaginally once or more(1). Aims and objectives of this study were to know the proportion and various indications of primary caesarean section in multipara. Methods : This was a prospective observational study of primary caesarean section in multipara women admitted at tertiary care hospital in western rural Maharashtra during the period of 1year from june2021 to june2022. Multipara with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >20 weeks gestation were included(2). Women with previous abortions and previous section were excluded. Results:During the study period of one year, total 8124 deliveries occurred, out of which 3000 (37.39%) underwent caesarean section and 386 (12.61%) were primary caesarean section in multigravida. Out of these multigravida patients who underwent primary caesarean section- most of the patients were unbooked (77.72%). Majority of the cases were direct admission in the hospital (61.13%). Maximum number of the patients were in the age group of 22- 30 years (55.95%). Two third of the patients were literate (69.44%) Maximum number of patients were Gravida 2 (48.72%). Almost all of them (94.85%) underwent emergency caesarean section. The most common indication for primary LSCS in multigravida patients was fetal distress 120 (30.79%) followed by malpresentation in 76 (19.39%) patients, severe pre ecclamsia and ecclamsia in 82 (19.39%), Obstructed labour in 36 (9.55%), and antepartum hemorrage in 43 (12.1%), Twin pregnancy in 29 (6.44%). Most common maternal complication was pyrexia 40 (10.36%) Most common indication for caesarean section in multipara was fetal distress followed by mal-presentation and severe pre-ecclampsia Conclusion and interpretation:From the above study it is very clear that, many unforeseen complications occur in woman who previously had a normal vaginal delivery, Present studyalso concludes that Fetal distress is a major contributor to primary CS in multigravida. Proper antenatal evaluation with early detection and management of high risk cases can reduce the likelyhood of intrapartum fetal distress