Objective: To find out the type and frequency of intra-operative difficulties encountered in patients with repeat cesarean deliveries. Study Design: An observational prospective study. Place And Duration: Department of Obstetrics and Gynaecology, Lady Goschen Hospital, Mangalore. The study period was from May 2014 to July 2015. Method: Pregnant women admitted in Department of Obstetrics & Gynaecology at Lady Goschen hospital through outpatient department or emergency from May 2014 to July 2015 with the history of previous cesarean and underwent repeat cesarean were included. They were divided into two group, women with previous one cesarean and another with previous 2 or more cesareans. Intra-operative difficulties noted in terms of dense adhesion, thinned out lower uterine segment, scar dehiscence, scar rupture, placenta praevia, adherent placenta, bladder injuries etc. Results: During the study period, 600 pregnant women with repeat cesarean were studied of which 536 had previous 1 cesarean & 64 with 2 or more previous cesarean. The frequency of dense adhesion, thinned out lower uterine segment, scar dehiscence, uterine rupture, placenta praevia, adherent placenta, bladder injury were 24.2%(130), 22.3%(120), 1.8%(10), 1.1%(6), 6.7%(36), 8%(16), 2.2%(12) respectively in patients with previous one cesarean and 50%(32), 40.6%(26), 3.3%(2), 3.1%(2),12.5%(8),31.2%(20) & 9.3%(20) respectively in 2 or more previous cesareans. Conclusion: Intra-operative difficulties in repeat cesarean patients increase with increase in number of prior cesarean. The frequency of thinned out lower uterine segment and scar dehiscence is more when inter pregnancy interval is less than 18 months.
