RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidates and address DR. SINDHU KOSARAJU

(in block letters) POST GRADUATE
DEPARTMENT OF OBTRETICS AND
GYNAECOLOGY
NAVODAYA MEDICAL COLLEGE
HOSPITAL AND RESEARCH CENTER,
RAICHUR-584103.

Permanent Address DR. SINDHU KOSARAJU,

D/O K.RAMANAMURTHY,
SAI PATHAM APARTMENTS,
FLAT NO. 401, ALAPATI NAGAR,
SULTANABAD, TENALI,
GUNTUR DIST, AP
PH-8884432703.
2. Name of Institution NAVODAYA MEDICAL COLLEGE & HOSPITAL
AND RESEARCH CENTER,
RAICHUR-584103.
3. Course of study and subjects M.S (OBG)
(3 YEARS)
4. Date of admission to the course 31st MAY 2012

5. Title of topic COMPARITIVE STUDY OF MATERNAL

MORBIDITY IN PRIMARY AND REPEAT
CESAREAN SECTION

6. BRIEF RESUME OF THE INTENDED WORK

6.1 Need for the study

Women are almost three times more likely to have a caesarean birth now than they
were twenty years ago (Fran come et al, 1993) this rise is attributable to many factors,
vastly due to improved safety of the operation and better anesthetic techniques but
there were also fear of litigation (Savage and Fran come, 1993). 2 Prospective study was
made by Anuradha kumar et al, from Sept. 1993 to May 1994. 15.8% of patient had
elective and 84.2% had emergency caesarean section. The incidence of primary
caesarean including elective and emergency was 14.8% out of 1418 deliveries. 3

However Hall and bewley in 1999 stated that emergency cesarean delivery
was associated with an almost 9fold risk of maternal death compared with that of
vaginal delivery and elective cesarean section was associated with an almost 3fold
risk. Increase in rates of severe obstetrical complications was associated with rising
in cesarean delivery rate. The maternal morbidity rate was increased twofold with
cesarean delivery compared to vaginal delivery. All the morbidities and increased
recovery time resulted in twofold increase of cost for cesarean delivery compared
to vaginal delivery.5

The objective of this study is to compare the maternal morbidity during and
after primary cesarean section with that of repeat cesarean section
6.2 REVIEW OF LITERATURE:

The term Caesarean is for abdominal delivery of a child by cutting through the
abdominal wall and the uterus was perhaps derived from Lex regia which later
became known as Lex caesarica (Caesars law). Towards the end of eighteenth
century, it was performed in recently dead or moribund women to extract and save the
baby. In the nineteenth century, it was done on the living women with a reasonable
chance for the womens survival. The first recorded cesarean section on living women
was done in 1,500 AD, performed by a person of Swiss nationality, Jacob Nufer on his
wife. In U.K. the first recorded on living women was performed in Edinburgh by
Robert smith 1.

V. Kamala Jay Ram reported study in five year. Out of 16782 deliveries, the
caesarean rate was 16%, because of associated risk factor and late referrals. In this,
62.75% was Primary caesarean section and 37.25% was repeat caesarean, among the
Primary caesarean 91.4% were emergencies and 8.6% were elective cesarean section.4

Between 1989 and 1996 the total cesarean rate decreased as result of decrease in
primary and increase in rate of vaginal birth after cesarean(VBAC) but since 1996 the
rates of primary and repeat cesareans have increased.6

Absolute indications for cesarean section are cephalopelvicdisproportion,

transverse or oblique lie of fetus, placenta previa of severe degree(2 nd degree
posterior,3rd, 4th degree),severe placental abruption, prolapsed umblical cord, severe
pre-eclampsia, eclampsia. Relative indications are fetal distress, failure to progress,
multiple births, breech, previous cesareans, large babies. 4 A 7year retrospective study
showed that main indications are fetal distress-22.4%, failure to progress-22.1%,
fetopelvic disproportion 22.1%, malpresentation- 20.4%.4

Anuradha Kumar et al, studied that hemorrhage was the most common
intraoperative complication observed in 10% of cases.3 Atonic PPH were seen in high
risk cases. Bladder injury and difficulty in approaching the lower uterine segment
 occurred in cases of repeat sections.Intra operative hemorrhage is commonest in
elective cesarean due to adhesions from previous cesarean section.7

Women having their fourth or more cesarean delivery had a 9 to 30 fold increased
risk of placenta accreta and 4 to 15 fold higher risk of hystrectomy. 8 In cases of
placenta previa, the risk of placenta accreta was 40% for those having their third
cesarean and over 60% for fourth or greater ceasarean delivery.9

6.3 Objectives of the study

1. To study intra operative and postoperative maternal morbidity up to end of 1st

week in primary and repeat cesarean section in singleton pregnancies.
2. To compare these incidences of morbidity in primary and repeat cesarean
section in intra operative and immediate postoperative period.

7. MATERIALS AND METHODS

TYPE OF STUDY :

Randomized prospective clinical study of 100primary and 100repeat cesarean
section in term singleton pregnancies.

DURATION OF STUDY:

January 2013 to December 2013

Statistical analysis will be done by using student t test and other relevant
statistical methods.

7.1 Source of Data

Study includes all women who will undergo cesarean section both primary and repeat
cesarean at the department of OBG, Navodaya medical college hospital and research
center, Raichur.
 Inclusion Criteria:

1. All term singleton pregnant women with gestational age greater than or equal to
37 weeks are accepted for study.

Exclusion Criteria:

1. Multiple pregnancies
2. Cesarean section done before 37 weeks gestation.

Method of collection of data:

1. All the complications observed in intra operative and postoperative period up

to end of first week are noted.

2. Preoperative and postoperative complications leading to maternal morbidities

are noted, investigated, evaluated, compared and treated accordingly.

7.3 Does the study require any investigations or interventions to be conducted on

Patients or other humans or animals? If so please describe briefly.

Yes

The following general investigations could be of use:

Heamoglobin percentage, total blood count, differential count.

HIV after counseling and HbsAg, blood grouping and Rh typing.
Routine urine examination
Ultra Sound abdomen
Pus or discharge from the wound if present for culture and sensitivity
Postpartum urine culture and sensitivity if urine infection is present
All investigations required for pregnency induced hypertension,
gestational diabetes, thyroid, cardiac diseases in pregnancy and or any
other medical disorder associated with pregnancy.

7.4 Has ethical clearance been obtained from institution in case of 7.3?
 Yes, ethical clearance has been taken from ethical clearance committee of the
institution.

8 REFERENCES

1)Cunningham F G, Ghant N, Leveno K. 2001 Caesarean delivery and post partum

hysterectomy. In Williams Obstetrics. 21st Ed. Mc Graw Hill. p. 537-553.

2) Dickinson J E. D. K. James, P. J. Steer, C. P. Weiner, eds. 1999 Caesarean Section

in High Risk Pregnancy options. 2nd edn Saunders, p 1217 1244.

3)Anuradha Kumar, Sita Thakur, Preme H K,Gupta K B. 1996 Maternal

complications in caesarean section deliveries . J. Obstet. Gynecol. of India,; 20: 36-
40.

4) Kamala Jayaram V. 1996 Caesarean section 5year analysis J. Obstet. Gynecol.

India,; 47: 57-59.

5)Williams obtretics 23rd edition page 545-548.

6)Martin J A, Hamilton BE, Sutton PD, et al. Births: final data for 2005. National
vital statistics reports, vol.56 no 6. Hyattsville (MA): National Center for Health
Statistics;2007.

7)Sirju Singh A, Poopnarine Singh A J, Bassaw B. 2001 Caesarean section delivery

in Trinidad J.Obstet. Gynecol.; 21(8): 236-238.

8)Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. 2004 Multiple
cesarean section morbidity. Int J Gynaecol Obstet;87:227-32.

9. Signature of Candidates
10. Remarks of Guide THIS STUDY IS RECOMMENDED AS IT
DEALS WITH COMPLICATIONS
WHICH LEAD TO MATERNAL
MORBIDITY AND GIVES AN INSIGHT
OF WHETHER PRIMARY OR REPEAT
CESAREAN SECTION HAS LESS
MATERNAL MORBIDITY.

11. Name and designation

of the (In block letters)

11.1 Guide DR. B.K. JEENA

PROFESSOR & UNIT CHIEF,
DEPARTMENT OF OBG,
NAVODAYA MEDICAL COLLEGE,
RAICHUR.

11.2 Signature

11.3 Co-guide

11.4 Signature

11.5 Head of the Department DR. Mrs.SHEELA.M. KODLIWADMATH,

HEAD OF THE DEPARTMENT,
DEPARTMENT OF OBG,
NAVODAYA MEDICAL COLLEGE &
HOSPITAL, RAICHUR.

11.6 Signature

12 12.1 Remarks of the chairman and

principal

12.2
Signature