FREQUENCY OF COMMON MATERNAL MORTALITY AND MORBIDITY AMONG PREGNANT WOMEN PRESENTING WITH PREVIOUS CESAREAN SECTIONS AT TERM

Abstract

Background: Women with prior cesarean sections are known to face elevated risks of maternal complications in subsequent pregnancies. However, the precise frequencies of maternal morbidity and mortality in such populations require ongoing study in different clinical contexts. This study aimed to assess the frequency and spectrum of common maternal morbidities including placenta accreta and cesarean-related surgical morbidity and any mortality among pregnant women presenting at term with previous cesarean sections.

Methods: A descriptive cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Hayatabad Medical Complex, Peshawar, over six months (October 2020 to April 2021). A total of 155 eligible women, aged 20–45 years, with singleton pregnancies at 28–37 weeks and a history of previous cesarean, were enrolled via consecutive sampling. Women with primigravida status, second-trimester bleeding, or uterine scars from non-cesarean surgeries were excluded. Clinical data, obstetric history, and ultrasound evaluation for placenta previa were recorded. Intraoperative and postoperative findings were used to identify cases of placenta accreta and cesarean morbidity (including wound infection, bladder or bowel injury, and surgical site hematoma). Maternal morbidity (postpartum hemorrhage, placenta previa, placenta accreta, cesarean morbidity, chorioamnionitis, and thromboembolic events) and mortality were documented. Data were analyzed using SPSS v20; continuous variables were expressed as mean ± SD and categorical variables as frequencies and percentages. Chi-square tests and stratified analyses were used to explore associations, with p < 0.05 considered significant.

Results: The mean age was 31.9 ± 6.5 years, and mean parity was 2.6 ± 1.1. The most common prior cesarean indication was malpresentation (34.8%). No maternal deaths occurred. Maternal morbidity included postpartum hemorrhage in 21.3%, placenta previa in 7.7%, placenta accreta in 3.2%, cesarean morbidity in 5.2%, chorioamnionitis in 7.1%, and thromboembolic events in 6.5%. Stratified analyses by age, parity, and prior cesarean indication did not reveal statistically significant associations (p > 0.05).

Conclusion: This study demonstrates that among women with previous cesarean sections at term, postpartum hemorrhage is the most predominant morbidity, followed by placenta previa, cesarean morbidity, chorioamnionitis, thromboembolic events, and placenta accreta. No maternal mortality occurred. The inclusion of placenta accreta and cesarean-related morbidity underscores the cumulative surgical and placental risks associated with repeat cesarean deliveries. These findings reinforce the importance of vigilant antenatal surveillance, preparedness for hemorrhage management, prevention of surgical complications, and individualized risk stratification in women with uterine scars.