OBJECTIVE: To find out the type and frequency of intraoperative complications encountered in
patients who had repeat cesarean section.
STUDY DESIGN: Observational Study.
PLACE AND DURATION: The Gynaecology & Obstetrics Unit – III in Liaquat University Hospital
Hyderabad. The study period was from July 2005 to July 2006.
METHOD: This study included the women who had repeat cesarean section during the period
from July 2005 to July 2006. These women were divided into three groups, group I (GI) included
the women with previous 1 cesarean section, group II (GII) included the women with previous 2
cesarean section and group III (GIII) included the women with previous 3 or more cesarean sections.
Intraopratieve complications were noted in terms of dense adhesion (with omentum,
bowel, uterus and bladder), extremely thinned out lower uterine segment, scar dehiscence, ruptured
uterus, placenta praevia, bladder injury, adherent placenta and fetal demise.
RESULTS: Out of 240 repeat cesarean sections, cases included in GI were 114 (47.5%), in GII
were 90 (37.5%) and in GIII were 36 (15%). Dense adhesions were found in 26 patients of group I
(22.8%), in 32 patients of Group II (35.5%) and in 7 patients of group III (19.4%). Extremely
thinned out lower uterine segment was found in 10 patients of group I (8.7%), in 15 patients of
group II (16.6%) and in 3 patients of group III (8.3%). Scar dehiscence was observed in 9 patients
of group I (7.8%), in 4 patients of group II (4.4%) and in 2 patients of group III (5.5%). Ruptured
uterus was seen in 3 patients of group I (2.6%) and in 1 patient of group II (1.1%). Bladder was
injured in 1 patient of group I (0.8%) and in 1 patient of group II (1.1%). Cesarean hysterectomy
was performed due to morbidly adherent placenta in 1 case of group I (0.8%) and in 1 case of
group III (2.7%). Fetal demise occurred due to ruptured uterus in 3 cases of group I (2.6%) and in
1 case of group II (1.1%).
CONCLUSION: Women with repeat cesarean section are at risk of having multiple intraoperative
surgical complications, which may increase the rate of maternal and fetal morbidity and fetal
Cesarean section, repeat cesarean section, intraoperative complications.