title: Maternal morbidity in emergency versus elective caesarean section at a tertiary care hospital.
abstract: BACKGROUND
  In the past 30 years the rate of caesarean section (C/S) has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section.
  
  
  METHODS
  It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward.
  
  
  RESULTS
  There were 50 patients in each group. In group A, 11 (22%) were booked and 33 (66%) were referred cases. In group B, 48 (96%) were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 (20%) patients in group A, and 39 (78%) patients in group B, placenta previa, chorioamionitis, obstructed labour (6, 12% each); pregnancy induced hypertension and eclampsia in 5 (10%) cases in group A only. Intra-operative complications in group A were 48 (96%) vs 15 (30%) in group B (p = 0.000). Postoperative morbidity in group A was 50 (100%) and 26 (52%) in group B (p = 0.000). Intra-operative complication was haemorrhage in 46 (92%) cases in group A and 11 (22%) in group B. Anaesthetic complications were 40 (80%); prolonged intubation 25 (50%), aspiration of gastric contents 8 (16%), and difficult intubation 7 (14%) in group A. Ten (20%) cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 (82%) and 11 (22%) cases respectively.
  
  
  CONCLUSIONS
  Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.
authors.affiliation: Department Obstetrics and Gynaecology, Dow Medical College, Karachi, Pakistan. achiamme@gmail.com
authors.forename: Asifa
authors.initials: A
authors.lastname: Ghazi
authors.forename: Farah
authors.initials: F
authors.lastname: Karim
authors.forename: Ayesha Muhammad
authors.initials: AM
authors.lastname: Hussain
authors.forename: Tehmina
authors.initials: T
authors.lastname: Ali
authors.forename: Shazia
authors.initials: S
authors.lastname: Jabbar
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D062606:Tertiary Care Centers; D055815:Young Adult