Incidence and outcomes of pregnancies among pregnant mothers with previous cesarean scar in jimma university specialized hospital south west Ethiopia

Abstract

Background: Caesarean section is a relatively common procedure in obstetric practice and has some adverse effects on future pregnancies. 8-10% of obstetrics population has a previous cesarean section. However, there is a paucity of information on the incidence and outcome of pregnancies among pregnant mothers with previous Caesarean section scar in Jimma University Specialized Hospital. Objectives: To assess the incidence and outcomes of pregnancies among pregnant mothers with previous cesarean scar who delivered in obstetrics ward of Jimma University Specialized Hospital from January 1, 2013 to December 31, 2013. Methods: A hospital based descriptive cross sectional study was conducted on 258 pregnant mothers with pervious cesarean section from January 1, 2012 to December 31, 2013 in Jimma University Specialized Hospital. Data was collected by 10 trained Year II OB/ GYN residents using semi structured interviewer administered questionnaire and document review check list. Data was cleaned, edited, coded and entered to computer and analyzed by SPSS version 16.0 for window. Bivariate and multi variable logistic regression analysis was carried out to identify the independent predictors for the outcome of pervious cesarean section. Finally the results of the study were presented in frequency tables, bar graphs and texts. Significant association was declared at P<0.05. Result: Among total delivery of 3854 the proportion of mothers with previous cesarean scar was 6.69%. 131(50.8%) of them were in age range of 25-29 years, 231(89.5%) had single previous cesarean scar, 252(97.7%) had antenatal care, 153(68.2%) were eligible for vaginal birth after cesarean with success rate of 69(52.3%). 37(24.7%) previous cesarean section scar + x-factors and 32(21.3%) prolonged latent phase of first stage of labor were major indication for the current cesarean section. 212(82.2%) pregnancies in mothers with previous scar had favorable maternal outcome respectively. Intrapartum complications were 18(7%) non-reassuring fetal heart rate pattern, 5(1.9%) uterine rupture and 2(0.8%) scar dehiscence while 3 (1.6%) hysterectomies and 1(0.5%) iatrogenic bladder injury were intra operative complication.13(6.9%)postpartum hemorrhage, 5(2.6%)endometirits, 2(1.1%) wound infection and 1(0.5%) dehiscence were among postoperative complications. Perinatal mortality rate was 3.25 per1000 total births. Address AOR= 0.7,95CI:0.2-0.9, eligibility for VBAC AOR=0.6,95CI:0.2-0.9 and intrapartum complications AOR=4.0,95CI:1.5-23 were significantly associated with outcome of mothers previous scar where as Birth Weight AOR=6,95CI:0.9-32.9 and first minute Apgar score AOR=5.7,95CI:1.9-16.8 were significantly associated with neonatal outcome at P<0.05 Conclusion and recommendation: The study revealed that lower proportion of pervious CS scar with variety of complications to mothers, fetuses and neonates. Strengthening of ANC follow up at hospital and other health facilities, better maternal record keeping and farther more comprehensive and extended study were recommended.