This increased bleeding in EMCS group was due to the caesarian sections done after prolonged labour with stretched and edematous lower segment with impacted presented part causing extension of incision laterally into the uterine vessels.
In our Institute most of caesarian sections were done under regional anaesthesia.
Atonic PPH was reported in 12% and 4% of cases in EMCS and ELCS groups respectively (p=0.037).Two patients required caesarian hysterectomy in EMCS group, one for placenta praevia and another for atonic uterus and none in ELCS group.
So cases which are decided for caesarian mode of delivery should have a planned repeat caesarean section to minimize the number of Emergency caesarian sections and its associated maternal complications.
(3.) Lulu Al-Nuaim et al-outcome of emergency and elective caesarian sections Annals of Saudi Medicine volume 16 No 61996.