Background: Primary caesarean section in multigravida women with previous vaginal deliveries presents a significant obstetric challenge. Despite previous uneventful vaginal deliveries, these women may develop complications necessitating operative intervention. The study aimed to evaluate the fetomaternal outcomes in primary caesarean section in multigravida women.

Methods: A prospective, observational study was carried out in the Department of Obstetrics and Gynecology at a tertiary care hospital from July 2024 to December 2025. Multigravida women with > 28 weeks of gestation, having a previous vaginal delivery of a viable neonate and participated willingly were included in the study. All primigravida women, gestational age < 28 weeks, pregnant women with previous abortion, ectopic pregnancy, and previous uterine scar excluded from the study. Demographic details, antenatal profile, obstetric indications, intraoperative findings, postoperative maternal complications, and neonatal outcomes were reordered. Data thus analyzed categorically using the Statistical Package for the Social Sciences (SPSS) v.16.

Results: A total of 77 women with mean age of 28.97±4.52 years were enrolled in the study, with majority [33 (48.85%)] aged 26-30 years. Most patients were booked [53 (68.83%)], urban residents [47 (61.04%)] and belonged to lower middle socio-economic class [30 (38.96%)]. Emergency caesarean sections accounted for [54 (70.13%)] of procedures. Common indications for caesarean section included breech presentation (11.69%), meconium-stained liquor (10.39%), failed induction of labour (9.09%), oligohydramnios (9.09%), previous two LSCS (9.09%). Intraoperative complications occurred in 5.19% (atonic PPH 3.9%), and postoperative morbidity in 11.69% (secondary PPH 3.9%). Neonatal morbidity was 12.99%, with respiratory distress syndrome (5.19%) being the most common. Perinatal morbidity was 3.66% (3/82 neonates).

Conclusion: Primary caesarean section in multigravida women is associated with significant maternal and neonatal morbidity. Regular antenatal surveillance, timely referral, vigilant intrapartum monitoring, and prompt surgical intervention when required are important for achieving favourable fetomaternal outcomes.

KEYWORDS: Primary Caesarean Section, Multigravida, Vaginal Delivery, Fetomaternal Outcomes, Maternal morbidity.