Abstract

A STUDY ON LOWER SEGMENT CESAREAN SECTION IN A TERTIARY CARE HOSPITAL

Naveen Poojar C. M.*

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Abstract

Background: Caesarean section is a major operation, with great potential benefit, but also with substantial risks for both mother and baby.[1] Maternal mortality and morbidity are higher than for vaginal delivery, although rates are becoming lower with advances in technology.[2] Factors that have been associated with an increased risk of infection and infectious morbidity among women who have a cesarean delivery include emergency cesarean section, labor and its duration, ruptured membranes and the duration of rupture, the socioeconomic status of the woman, number of prenatal visits, vaginal examinations during labor, urinary tract infection, anemia, blood loss, obesity, diabetes, development of subcutaneous hematoma, the skill of the operator and the operative technique. Prophylactic antimicrobials are proved to be effective in lowering postoperative infections both in women at high risk (in labour after membrane rupture), and low risk (non-labouring with intact membrane). They are often administered after umbilical cord clamping. Objectives: 1. To assess the cause, indication, socioeconomic group involved and types of Lower segment Cesarean section. 2. To evaluate the pattern of Antimicrobial prophylaxis in Lower segment Cesarean section. 3. To assess the frequency of post operative morbidity. 4. To assess the ADR’s associated with Antimicrobial drugs used. Methods: It was a prospective observational study was conducted in the department of Obstetrics, Rajarajeshwari Medical College and Hospital, Bangalore. A study was conducted over a period of one year on 250 patients based on 20% of prevalence rate of lower segment cesarean section. The patients who underwent lower segment cesarean section (elective and emergency) was observed from the period of 1st dose of antimicrobial prophylaxis till the patient is discharged. Relevant information on each patient was collected according to the proforma designed for the study. Antibiotics used, their dose dosage schedule were recorded. Investigations like pus, blood and urine culture and sensitivity was done for patients with postoperative complications. Results: Out of 250 patients in the study, 59.2% (148) were Primigravida and 40.8 % (102) were Multigravida. 63.6% (159) patients underwent Emergency cesarean section, which was preferred over Elective cesarean section (36.4%). Meconium stained liquor is the most common indication for the cesarean section in 24.4% of the patients followed by Pre mature rupture of membrane in 16.85 of the patients. Two antimicrobials combination was most preferred in our study with 61.6% and three drug combination in 38.4 %. 56 Patients in our study developed post operative morbidity. Fever was most common which was seen in 32 patients, wound infection in 16 patients and UTI in 8 patients. Ecoli was the most common organism isolated from wound & UTI in our study followed by Klebseilla. Conclusion: Cesarean delivery is associated with a significantly higher post-operative infection (SSI, WI, UTI) rate than following vaginal birth and other surgical procedures. Overall, this study proved that, use of prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after cesarean section. Majority of the women received more than 1 antibiotic which is not in accordance with the antibiotic guidelines.

Keywords: Lower segment Cesarean section, Surgical site infections, Antimicrobial prophylaxis.