Background: Cesarean section is the most common done obstetric emergency and the outcome of surgery differs depending on various factors. Maternal and fetal outcome depends on proper follow up during antenatal period.

Objectives: To study them Maternal and fetal outcome and complications in rural referral patients (unbooked cases) undergoing emergency cesarean delivery and to compare them with booked cases undergoing emergency cesarean deliveries in   Raipur Institute of Medical Sciences.

Purpose: This study was undertaken to find out the difference in maternal and fetal outcome between booked cases with proper antenatal follow up and unbooked cases referred from rural health centres.

Method: The study is a cross-sectional study conducted at Raipur Institute Of Medical Sciences from October 2013 – September 2015 over a period of 2 years.560 cases of rural referrals (unbooked cases) undergoing emergency cesarean delivery were the study group. The control group consisted of 420booked cases undergoing emergency cesarean delivery. Various parameters of maternal morbidity, neonatal morbidity and mortality were compared in both the groups.

Results: Of the various factors analysed in relation to type of Cesarean delivery statistically significant association were found between emergency ceasearean and younger patients multi -parity, irregular attendance at antenatal clinic, no prenatal care, indications, intra operative complications and low Apgar scores (P<0.05).

Conclusion: Cesarean delivery done in rural referrals on emergency basis associated with significant intraoperative, postoperative morbidity and neonatal morbidity and mortality.

Every effort should be directed to proper antenatal care and planned cesarean delivery, as determined during antenatal period. Importance of an effective health care package and timely referral from peripheral hospitals should be stressed so as to reduce the various problems associated with emergency cesarean delivery.

Keywords: Emergency cesarean delivery, booked and unbooked, maternal morbidity, neonatal morbidity and mortality.

1. study of primary caesarean section in multipara. Int J Reprod Contracept Obstet Gynecol. 2013; 2(3):320-324. 
2. Bogg L, Diwan V, Vora KS,  A Impact of Alternative Maternal Demand-Side Financial Support Programs in India on the Caesarean Section Rates: Indications of Supplier-Induced Demand ,Maternal and Child Health J. 2015 Aug: 11.
3. Akolekar R, Pandit S N, Rao.B.S.. The cesarean Birth FOGSI publications, 1st ed. National Book Depot, reprint 2010; 1-3.
4. World health statistics. Part II, Global health indicators. Table 2, Cause specific mortality and morbidity. WHO 2015; . 64.
5. Samiksha S, G. V. S. Murthy, Anitha T, Sanjeev U, Murali K, Rajan S, S. R. Srikrishna. Maternal and Child Health Journal. 2015 Jul; 19(7):1447-1454.
6. Umesh Sabale, Alka Murlidhar Patankar. Study of Maternal and Perinatal Outcome in Referred Obstetrics Cases. Journal of Evolution of Medical and Dental Sciences. 2015 Mar; 4(26) :4448-4455.
7. Maternal United Nations Population Fund (UNFPA). Maternal Mortality Update 2002: A Focus on Emergency Obstetric Care. New York: UNFPA; 2003:8.
8. Indias health care system 2013:04; 20-22.
9. Greg R, Alexander , Carol C, Korenbrot, The future of children, The role of prenatal care in preventing low birth weight, Princeton university. 1995 Spring; 5(1) ,103-120.
10. Scholl, Theresa O, et al. Prenatal care and maternal health during adolescent pregnancy: A review and meta-analysis. Journal of Adolescent Health, Volume 15, Issue 6, 444-456.
11. Young JH. Caesarean Section: The History and Development of the Operation From Earliest Times. London, HK Lewis & Co Ltd, 1944.
12. National Library of Medicine. Caesarean Section – a brief history.    Accessed March 25th, 2004 from http://www.nlm.nih.gov/exhibition/cesarean/cesarean_ 2.html to …/cesearean_6.html
13. Boley JP. The History of Caesarean Section. CMAJ 1991; 145(4): 319-322
14. Gabert HA, & Bey M. History and development of Cesarean Operation. Obstetrics and Gynecology clinics in North America 1988; 15:591-605
15. Hillan EM. Caesarean Section: historical background. Scottish Medical Journal 1991; 36(5):150-154.
16. Cunningham F G, Leveno J K, Bloom S L. Williams Obstetrics. 23^rd USA: Mc Graw Hill; 2010
17. Martin JA, Hamilton BE, Ventura SJ, et al: Births: final data for 2010. Natl Vital Stat Rep 61(1):1, 2012.
18. Ministry Of Health and Family Welfare , Gov.Of. India. DLHS-3(2007-2008).
19. Baskett TF, Arulkumaran S. Intrapartum care. 2^nd London: RCOG Press; 2011. P. 155-168.
20. Renu M, Nupur G. Ian Donald’s Practical Obstetric Problems. 7^th New Delhi: Wolters Kluwer; 2014.
21. Kambo I, Bedi N, Dhillon B S,Saxena N C. A Critical Apprriasal of Cesarean section rates at teaching hospital in India. International Journal Gynecol and obstet 2002; 79 : 151-158.
22. Rosenstein MG, Kuppermann M, Gregorich SE, et al: Association between vaginal birth after cesarean delivery and primary cesarean delivery rates. 122:1010, 2013.
23. Holmgren C, Scott JR, Porter TF, et al: Uterine rupture with attempted vaginal birth after cesarean delivery. Obstet Gynecol 119:725, 2012.
24. A Mesleh Madawi Al Naim, Krimly R. Pregnancy outcome of patients with previous four or more cesarean sections. J Obstet Gynecol 2001; 21(4): 355-357.
25. Cunningham FG, Levon KJ, Bloom SL, Hanath JC, Rouse DJ, Spong CY. Abnormal labor-Williams obstetrics,23rd edition. Mc Graw Hill 2010 : 464.
26. Sizer AR,Nirmal DM. Occipito posterior position: associated factors and obstetric outcome in nulliparas. Obstet Gynecol 2000; Nov, 96(sept 1): 749-752.
27. Cheng YW, Shaffer BL, Caughery AB. The association between persistent occipito posterior position and neonatal outcome. Obstet Gynecol 2006: 107(4); 837-844.
28. Biswas A, Anandkumar C. Intrapartum fetal monitoring. Arulkumaran S,Ratnam S, Bhaskar rao K: The management of labour. Orient Layman ltd. 4 : 57-69, 1996.
29. Arulkumaran S, Penna KL, Bhaskar Rao K. Management of labour,2nd edition; universities press: 98-105.
30. The Netherlands Perinatal Registry, 2006.
31. A. Martin, B. E. Hamilton, P. D. Sutton, S. J. Ventura, F] “,Menacker, and M. L. Munson, “Births: final data for 2002 .National Vital Statistics Reports, . 52( 10) . 1–114, 2003.
32. Induction of labor—Clinical Guideline (NICE, NHS), July 2008.
33. Kwee, M. L. Bots, G. H. Visser, and H. W. Bruinse, “Obstetric management and outcome of pregnancy in women with a history of cesarean section in the Netherlands,” European Journal of Obstetrics & Gynecology and Reproductive Biology ,  132, no. 2, pp. 171–176, 2007.
34. J. Murphy, R. E. Liebling, R. Patel, L. Verity, and R. Swingler, “Cohort study of operative delivery in the second stage of labour and standard of obstetric care,” BJOG: An International Journal of Obstetrics & Gynaecology, vol. 110, no. 6, 610–615, 2003.
35. Ben-Haroush, N. Melamed, B. Kaplan, and Y. Yogev, “Predictors of failed operative vaginal delivery: a single-center experience,” The American Journal of Obstetrics and Gynecology, vol. 197, no. 3, pp. 308.e1–308.e5, 2007.
36. Chauhan A. Placenta previa. Pregnancy at risk. A practical approach to high risk pregnancy and delivery. Usha Krishna, 5th edition; FOGSI: 493-500.
37. Pariente G, Wiznitzer A, Sergienko R, Mazor M, Holcberg G, Sheiner E. Placental abruption: Critical analysis of risk factors and perinatal outcomes. J Matern Fetal Neonatal Med 2011;24:698-702.
38. Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. Placental abruption in the United States, 1979 through 2001: Temporal trends and potential determinants. Am J Obstet Gynecol 2005;192:191-8.
39. Bibi S, Ghaffar S, Pir MA, Yousfani S. Risk factors and clinical outcome of placental abruption: A retrospective analysis. J Pak Med Assoc 2009;59:672-4.
40. Witlin AG, Sibai MB. Perinatal and maternal outcome following abrouptio placentae. Hypertens Preg 2001;20:195-203.
41. Hussein L, Ingrid M, Siriel N M, Gunilla L, Lennarth N, BMC Pregnancy and Childbirth 2009, 9:13.
42. Enakpene CA, Omigbodun AO, Arowojulo AO. Perinatal mortality following umbilical cord prolapse. Int J Gynaecol Obstet. 2006 Oct; 95(1):44-45.
43. Baskett TF. Munro Kerr’s Operative Obsterics, 12^th ed,2014: Cord prolapse: p. 177.
44. Ofir K, Sheiner E, Levy A, et al. Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol. 2003;189:4.
45. Van Han MA, Van Dongen DW, Mulder J. Maternal consequences of cesarean section. A retrospective study of intra op and post op maternal complications of cesarean section during 10 yr period.Eur J Obstet Gynecol Reprod Biol 1997 Jul ; 74(1) : 1-6.
46. Donald I. Cesarean section. Practical obstetric problems. 6th edition, New Delhi. B I Publications 2009: 548-566.
47. Rogers RE. Complication at cesarean section. Obstet Gynecol clinics North America, vol 15(4) ; 1988 : 673-684.
48. Schneider H. Birth asphyxia-an unsolved problem of perinatal medicine. Z Geburtshilfe Neonatol ; 205 (6) ;2001 :205-212.
49. Hood DD. Anesthesia for cesarean section. Obstet Gynecol clinics, North America, vol 15 (4) ; 1988 : 639-652.
50. Cunningham F G, Leveno K J, Bloom S L, Hauth J C,Rouse D J, Spong C Y. Cesarean delivery and peripartum hysterectomy. Williams Obstetrics. 23rd edition. Mc Graw Hill 2010; 544-555.
51. Murphy KW. Reducing the complication of cesarean section. Bonnar J (ed) RA. Obstet Gynecol, vol 20, Churchill livingstone , Edinburgh ; 1998: 141-152.
52. Limaye H R, Ghadialli M V. Maternal and fetal outcome in obstetric emergency cases referred from rural area and recommen-dations to improve it. Journal of obstet and gynec of India 1982; 32 : 520-529.
53. Neilson TF, Hokegard KH. Cesarean section and intraoperative surgical complication. Acta Obstet Gynecol scand 1984 ; 63 : 103-108.
54. Onkapa B, Ekele B. Fetal outcome following cesarean section in a university teaching hospital. J of National Medical Association, 101(6) ; 1999:
55. Adhikari S, Dasgupta M, Sanghamita M. Management of obstructed labour: A retrospective study. J Obstet Gynecol India 55(1); 48-51.
56. Gupta N, Vaid S, Acharya V. A prospe-ctive study of 70 cases of obstructed labour. J Obstet Gynecol 1991 ; 41(1) : 52-55.
57. Nuiam L A, Soltan M H, Khashoggi T, Addar M, Chowdhury N, Adelusi B A. Outcome in elective and emergency cesarean sections: A comparative study . Annals of Saudi medicine 1996; 16 (6): 645-649.
58. Vinaya Pendse et al; Profile of Booked vs Unbooked Delivery cases; Journal of Obstetrics and Gynaecology of India; 1989 Aug vol. 34 (4); 466 - 471
59. Jassawalla M.J. et al; Maternity care monitoring; Journal of obstetrics and Gynaecology of India; 1985 . 399 to 403.
60. Badole C.M. et al; Fetal Growth; Association with maternal dietary intake, haemoglobin" and antenatal care in rural area, Journal of Obstetrics and Gynaecology of India; Vol. 1992, 42, Pg 32 – 36.

Dr Neerja Agarwal

Assistant Professor  Department of OBG Raipur Institute of Medical Sciences Raipur

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