Intra-operative Maternal Complications of Emergency Cesarean Section Done in Advanced Labor

Abstract

Abstract

Background:  Emergency cesarean section done in advanced labor is a big challenge in obstetrics due to increased risk of intraoperative complications. In the last decade, a rapid increase in cesarean section done in advanced labor has been observed. Difficult deli-very of the fetal head during cesarean section carries a high risk of intraoperative complications like cervical and uterine tears, intra operative hemorrhage and trau-ma to the baby.

Objectives:  The purpose of this study is to find out the frequency and risk factors for intra-operative com-plications in emergency cesarean section done in adva-nced labor, so that appropriate management protocols can be planned to reduce these complications.

Study Design:  Prospective cohort study.

Materials and Methods:  This prospective study was carried out in Obstetrics and Gynecology Unit - 2 of Services Institute of Medical Sciences, Services Hos-pital, Lahore; from 1^st January 2007 to 31^st December 2007. All patients undergoing emergency cesarean sections done on laboring mothers were included in the study. The sample was divided into two groups; emergency C-section done in advanced labor as the study group and emergency C-section in early labor as the control group. Data were collected regarding age, parity, booked or unbooked status, indications for ces-arean section, level of competence of operating sur-geon, intra-operative complications and the risk factors for these complications. Data were recorded on a stru-ctured proforma and compared between the two gro-ups.

Statistical Analysis:  Data were analyzed using com-puter programme SPSS Version 14 for windows appl-ying student t-test for quantitative and chai square test for qualitative parameters. A p-value < 0.05 was used as statistically significant.

Results:  Out of 2064 total deliveries in the year 2007, 1290 (62.5%) were vaginal deliveries and 774 (37.5%) were C-Sections. Out of 774 C-Section, 174 (23%) were elective and 600 (77%) were emergency. Out of 600 emergency C-sections, 402 (59%) were done on laboring mothers and 198 (41%) were done on non-laboring mothers for indications like placenta previa, eclampsia, etc. Out of 402 C-sections done on laboring mothers, 241 (60%) were done in advanced labor and 161 (40%) in early labpr. The intra-operative compli-cation rate was 19.8% versus 11% (p-value 0.001) in the study and control group respectively. The main indications for cesarean section in labor were prolonged labor, deep transverse arrest of fetal head and fetal distress. The main complications noticed were the cer-vico - uterine lacerations and intra-operative hemorr-hage. Factors associated with increased maternal com-plications were; un-booked cases (p-value 0.01), stat-ion of the fetal head (p-value 0.02), good size baby (p-value 0.01) and experience of surgeon (p-value 0.04).

Conclusion:  Emergency cesarean section done in advanced labor is a high risk operation with significant maternal morbidity in terms of cervico - uterine tears and intra-operative bleeding.

Key Words:  Emergency cesarean section, advanced labor, maternal complications, cervicouterinetears, intraoperativehemorrhage.