Yamuna, R G (2018) A comparitive study of indications and fetomaternal outcomes in primary cesarean section in primi and multi gravida. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.
|
Text
220601018yamuna.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: As the current price in caesarean delivery has profound impact on maternal and child health, there are also social and economical repercussions associated with increase in caesareans that are not yet well understood. This dissertation examined several increasingly common factors including induction of labour and advanced maternal age that might also be associated with increased risk or increased likelihood of caesarean delivery. Additionally provider characteristics and experienced information were collected via a comparative study to explore clinician level information to identify factors that cause rise in caesarean section. AIMS AND OBJECTIVES: The aim of this study is to assess the incidence and more common indications in primigravida and multigravida undergoing primary caesarean section, and hence help in reducing caesarean section rates wherever possible by knowing unnecessary indications. We also study the fetomaternal outcome in both groups and thereafter evaluate where we can intervene to improve the same, and hence reduce maternal morbidity and improve fetal outcome. MATERIALS AND METHOD: SOURCE OF DATA; Patients admitted in Government Mohan Kumaramangalam Medical College, Salem, undergoing primary cesarean section, between July 2016 and June 2017. Study Design: Randomized Controlled Trial. Sample Size: 200 women 18-30yrs of age undergoing primary caesarean section. Place of Study: Government Mohan Kumaramangalam Medical College, Salem. Period of study: July 2016-June 2017. 200 patients aged 18-30 years pregnancy >28wks undergoing primary caesarean section (100 will be primi and 100 will be multigravda) will be included in this prospective, randomized, study after obtaining approval of the local ethical committee and an informed written consent from all participants Inclusion Criteria: 1. Women between 18-30 years, 2. with > 28wks of gestation, 3. without previous uterine surgeries. Exclusion Criteria: 1. patient refusal, 2. previous lscs, 3. previous hysterotomy, 4. previous myomectomy, 5. detoriation of renal/liver function. RESULTS: Statistical methods: Gravida, Age, Indications like Fetal distress, CPD, Malpresentation, Placenta previa, failed induction, non progression of labour, obstructed labour, IUGR, severe oligohydramnios were compared. Maternal outcomes like PPH, Blood transfusions postoperatively, post op fever/Wound sepsis, Newborn APGAR and NICU admissions are considered as outcome variables. Primigravida and multigravida who are all underwent caesarean section for the first time were consider as primary explanatory variable. Demographic age, was consider as other explanatory variable. Descriptive analysis: Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Data was also represented using appropriate diagrams like bar diagram, pie diagram and box plots. Both the study groups, were compared with respect to all the potential confounding baseline variables. CONCLUSION: Our study is a comparative study including 200 patients, 100 primigravida and 100 multigravida, done over the period of one year during June 2016 to June 2017 in our hospital, Government Mohan Kumaramangalam Medical College Hospital, Salem. The need for the study is the increasing rates of caesarean delivery all over and also in our institution, and hence a study of indications and fetomaternal outcomes would be of help in reducing the same. Age distribution in this study group, maximum number of primigravidas were < 25yrs and in multigravidas maximum number were in 31-35 years. Those who were < 25years are prone for adolescent health problems like anaemia, where as multigravidas are prone for age related disease like hypertensive disorders, diabetes mellitus, obesity, incidence of big baby ,spondylolisthesis of joints. These age related problems are risk factors for caesarean section. Indications & fetomaternal outcomes were compared in both groups. In this study, among the indications, most common was failed induction of labour. Caesarean section done for non progression of labour was significantly high in multigravida compared to primigravida. Analysing the most common indication in primigravida, we found that fetal distress was the first common indication. The maternal outcome was measured in terms of PPH, wound infection and wound sepsis. PPH was most common in multigravida due to the obvious reason of atony being commoner in multi, and also our observation that non-progress being the most common indication in multi, there was more chances of extension of LSCS incisions due to thinned out lower segment and more atonicity in the second stage of labour. This is due to the fact that most multigravida are admitted or referred in the later stage of labour after tolerating more pain or after waiting for normal labour upto later stage. This can be reduced by earlier admission and earlier referrals. The incidence of wound infection was equal in both the primi and multigravida and there was no significant difference between the two groups. Regarding the fetal outcomes, the NICU admissions were more in the multigravida. Our inference is that, this is due to nonprogress of labour being more common in the multi meaning that delayed decision for caesarean in these patients were the cause for NICU admissions being more in this group. Though the primi group was taken up more for fetal distress the apgar scores and NICU admissions were better in them. Our conclusion is that this maybe the group having unnecessary sections due to early interventions. This can be reduced by more standardised fetal heart monitoring and avoiding hasty decisions.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | indications ; fetomaternal outcomes ; primary cesarean section ; primi and multi gravida ; comparitive study. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Jul 2018 03:22 |
| Last Modified: | 17 Jul 2018 03:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8876 |
Actions (login required)
 |
View Item |
