6 previous Caesarean births complicated by 2 previous uterine ruptures and a failed bilateral tubal ligation in the last confinement : Caesarean section again for the 7th time with tubal ligation

Abstract

Caesarean section (CS) is a life saving surgical procedure of both the mother and the baby . Increasing number of caesarean births presents a challenge to the parturient and the managing obstetrician. The risk of surgical injuries, rate of blood transfusions, and adhesion formation all rise with increasing number of caesarean sections. Moreso, the number of uterine rupture and hysterectomies has been found to be on the increase with  repeat CS in many studies..

We present a 37 year old Gravida 7,Para 6+0,3 alive  a case of 6 previous caesarean deliveries with 2 uterine repair for ruptured uterus during her second and fifth confinements where she had fresh still born babies with 2 and 3 units of blood transfused respectively. She had bilateral tubal ligation(BTL) using the polmeroy’s method in her sixth confinement However she was seen in her seventh confinement as soon as she was confirmed to be pregnant. She was counselled for a repeat elective CS at term. She was also counselled on contraceptive options available, she opted for a repeat BTL. At 38weeks of gestation, she had an elective CS with repeat BTL using the polmeroy’s method. A live male neonate that weighed 3.4kg with APGAR scores of 8¹ and 9⁵ was delivered. There were dense adhesions between the uterus and anterior abdominal walls. The lower uterine segment was very vascular. The right uterine tube appeared normal while the left tube appeared kinked at the isthmic region. Both round ligaments appeared normal

Conclusion:  Detailed and thorough counselling of parturients with multiple caesarean sections on the potential challenges with further caesarean birth is apt. Tubal sterilization is highly effective but can fail. Patients should be counseled at the outset about the contraceptive options that are available should sterilization fail.

Key words: 6  Previous caesarean section, ruptured uterus ,Failed BTL, repeat CS