Abstract

Introduction: Caesarean section is a life-saving obstetric intervention when appropriately indicated; however, its increasing use among multiparous women with previous successful vaginal deliveries has become a matter of clinical concern. Evaluating the factors contributing to primary caesarean section (CS) in this group is essential for optimizing maternal and neonatal outcomes and promoting evidence-based obstetric care. Objectives: To determine the incidence, indications, associated antenatal risk factors, maternal and neonatal outcomes, and Robson ten group distribution of primary caesarean sections in multiparous women. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, over a period of one year (2022–2023). Multiparous women with at least one previous vaginal delivery beyond 24 weeks of gestation who underwent their first caesarean section were included. Relevant demographic, clinical, obstetric, and neonatal data were collected and analysed. Caesarean sections were further categorized using Robson’s Ten-Group Classification System. Results: Among 3,759 deliveries, 241 women underwent primary caesarean section, yielding an incidence of 12.98%. Most participants were unbooked referrals and belonged to lower socioeconomic strata. Anaemia (46.47%) was the commonest antenatal risk factor. Emergency procedures accounted for 89.21% of surgeries. Foetal distress emerged as the leading indication for caesarean section (40.25%), followed by breech presentation (19.92%) and major placenta previa (19.09%). Maternal complications were infrequent, with postpartum haemorrhage and wound disruption being the most common. No maternal mortality was recorded. Robson Group 10 contributed the largest proportion of primary caesarean sections (45.23%). Conclusion: Foetal distress remains the predominant indication for primary caesarean section in multiparous women. Strengthening antenatal care, encouraging timely referrals, and applying Robson’s classification can facilitate targeted interventions, improve obstetric decision-making, and contribute to reducing avoidable caesarean deliveries.

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