Primary Cesarean Section in Multigravida Women: Trends and Outcomes in a Tertiary Care Setting

A primary cesarean in a multigravida refers to the first cesarean section (CS) performed on a woman who has previously delivered vaginally at least once. This study aimed to assess the incidence and indications of primary CS in multigravida women and their feto-maternal outcomes.

This study was conducted in the Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India, from June 2022 to May 2024. A total of 5,280 women delivered in our department during this period, of whom 476 multiparous antenatal women undergoing primary CS were evaluated.

The incidence of primary CS in multigravida women was 39.47%, most of which were emergency CS. The most common indication for CS was fetal distress (26.47%), followed by malpresentation in 21.43% of women. Among the feto-maternal complications, 21.85% of women developed complications such as transfusion reaction (12.18%), upper respiratory tract infection (URTI) in 8.19%, puerperal pyrexia in 5.46%, and postpartum hemorrhage in 4.20% of women. Respiratory distress syndrome was the most common cause of neonatal morbidity (6.93%).

Multiparity increases the risk of complications in the antepartum and intrapartum periods, necessitating operative interventions in certain conditions. Efficient antenatal evaluation and early identification and management of high-risk women can help decrease the incidence of unwarranted complications leading to emergency cesareans in multigravida patients. Additionally, regular audits of the same can help optimize the incidence of CS in these women.