Medical comorbidities in cesarean section patients at a Western India tertiary center: A prospective study on their prevalence pattern, anesthesia management, and maternal outcomes

Background: Advances in medical care have enabled more women with preexisting medical conditions to undergo pregnancy, increasing the need for high-risk obstetric and anesthetic care. This study aimed to assess the prevalence pattern of medical comorbidities in patients undergoing cesarean section (CS), their anesthetic management, and maternal outcomes. Materials and Methods: A prospective, observational study was conducted over a 1-year period at a tertiary level public sector medical college hospital wherein, out of 5933 cesarean deliveries, 114 patients (1.92%) with preexisting medical comorbidities as per the Obstetric Comorbidity Index and the Ministry of Health and Family Welfare, India, were included. Data on patient demographics, comorbidities, anesthesia technique, and maternal outcomes were recorded and analyzed. Results: Out of 114 (1.92% of total CS deliveries) patients with medical comorbidities, severe anemia (31%), cardiac (19.3%), and respiratory (18.4%) diseases were the most prevalent. Emergency CS comprised 59% of cases, and regional anesthesia (RA) was used in 71% of CS. Multidisciplinary consultation was sought for 47.4% of cases and 36.8% were managed in the intensive care unit (ICU). Severe maternal morbidity occurred in 16 (14%) patients (postoperative ventilation-8, shock-6, and pulmonary edema-2), and later maternal mortality occurred in 2 (1.75%) patients, attributed to severe acute respiratory illness-related acute respiratory distress syndrome. Twenty neonates were transferred to the neonatal ICU, with 5 neonatal mortalities (4.38%). Conclusion: The prevalence of CS with medical comorbidities was 19.2 per 1000 deliveries, wherein severe anemia, cardiac, and respiratory diseases were the leading comorbidities. A majority of CS were performed in emergencies and in two-thirds of cases RA was used. Nearly half required multidisciplinary care, with one-third managed in the ICU, leading to a 98.2% maternal survival rate and a 95.6% neonatal survival rate.