Abstract：
The spectrum of indications for primary caesarean section changes with advancing parity. As parity advances more cesarean section are done for maternal rather than fetal indications. The objective of this study was to determine the indications and complications of caesarean section in multiparous women with history of previous vaginal delivery. This cross-sectional descriptive observational study was conducted in Mymensingh Medical College Hospital from January 2019 to June 2019 among 100 purposively selected multiparous women who underwent primary caesarean section. A well-designed, semi-structured questionnaire was used to collect data by face-to-face interview, clinical examinations and laboratory investigations. Data analysis was conducted in SPSS 20.0 version. Majority (74.0%) of the women in this study were in the age group 21-30 years with mean age of 26.3±5.76 years. Majority of the patients were of second gravida (42.0%) followed by third gravida (33.0%). The highest gravida in this study was 6th. Most of the patients were of para 1(44.0%). Highest para in this study was para 5. The most common indication of caesarean section in this study was foetal distress (26.0%). The next common indications were cephalo-pelvic disproportion (22.0%), antepartum haemorrhage (13.0%), mal-presentaion or mal-position (16.0%). Other causes were PROM (8.0%), prolonged labour (6.0%), cord prolapse (2.0%), post-dated pregnancy (4.0%), severe pre-eclampsia (2.0%) and secondary subfertility (1.0%). There was no case of maternal mortality in this study but 15 mothers suffered from various post-operative complications like wound infection (4.0%), UTI (4.0%), puerperal pyrexia (3.0%), postpartum haemorrhage (3.0%) and paralytic ileus (1.0%). Among the babies delivered 97 were live births. Among the 97 live births 11(11.34%) were preterm babies. Among the babies delivered majority (85.0%) was with good APGAR score (7-10). In conclusion it can say that a multiparous women in labour requires the same attention as that of primigravida. A parous women needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate.
摘要：
初次剖腹产的适应症范围随着胎次的增加而变化。随着胎次的进步，更多的剖宫产是针对产妇而不是胎儿的指征。这项研究的目的是确定先前有阴道分娩史的经产妇女剖宫产的指征和并发症。这项横断面描述性观察性研究于2019年1月至2019年6月在Mymensingh医学院附属医院对100名接受原发性剖腹产的有意选择的经产妇女进行了研究。一个精心设计的，半结构化问卷通过面对面访谈收集数据，临床检查和实验室检查。数据分析采用SPSS20.0版。本研究中大多数（74.0％）的女性在21-30岁年龄段，平均年龄为26.3±5.76岁。大多数患者是第二次妊娠（42.0％），其次是第三次妊娠（33.0％）。在这项研究中，最高的孕妇是第6位。大多数患者为第1段(44.0%)。本研究中最高的段落是第5段。在这项研究中，最常见的剖宫产指征是胎儿窘迫（26.0％）。下一个常见的适应症是头骨盆不相称（22.0％），产前出血（13.0%），mal-presentaion或mal-position（16.0%）。其他原因是PROM（8.0％），长期分娩(6.0%)，脐带脱垂（2.0%），过期妊娠（4.0%），重度子痫前期（2.0％）和继发性低生育（1.0％）。在这项研究中没有产妇死亡的病例，但15名母亲患有各种术后并发症，如伤口感染(4.0%)，UTI（4.0%），产褥期发热（3.0%），产后出血(3.0%)和麻痹性肠梗阻(1.0%)。分娩的婴儿中有97名是活产。在97例活产婴儿中，有11例（11.34％）是早产婴儿。在分娩的婴儿中，大多数（85.0％）具有良好的APGAR评分（7-10）。总而言之，可以说，多胎分娩的妇女需要与primigravida同样的关注。产妇需要良好的产科护理，以改善产妇和新生儿的结局，并且仍将剖腹产率保持在较低的水平。
