sepsis

This observational study assessed the knowledge of pregnant women attending antenatal clinics at two selected hospitals in Abeokuta South, Nigeria on the causes and risk factors of maternal mortality, identified barriers to knowledge acquisition, and examined the influence of parity of respondents on their knowledge of factors causing maternal mortality. Maternal mortality is extremely high in Nigeria, it is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Descriptive research design was used in this study and qualitative data from 136 respondents selected randomly, were obtained through a self-designed questionnaire that comprised three sections. Data were analyzed and indicated that parity of the pregnant women do not have an influence on their knowledge of factors responsible for maternal mortality. Findings revealed that majority (67.6%) of the respondents had high knowledge on the causes of maternal mortality – haemorrhage, sepsis, prolonged/obstructed labour, anaemia, unsafe abortion, infection, hypertensive disorders, care rendered by unskilled medical practitioners and its risk factors - parity, poverty, place of last delivery and low attendance at antenatal clinic. Educational background, marital status, irregular antenatal visits, socio-cultural practices and occupational status were identified as barriers to knowledge acquisition. This paper concluded that pregnant women may have a high knowledge about the factors responsible for maternal mortality. This is probably due to the fact that all respondents had formal education and because they were interviewed on antenatal clinic days, which suggests that they might have heard about the causes and risk factors for maternal mortality during their visits. Authors recommended that government should employ qualified health professionals and provide medical subsidy, it is hoped that this will ensure that pregnant women get quality care throughout the period of pregnancy and delivery.

The aim of this study was to investigate and compare the complications including infection and mortality associated with enteral and parenteral nutrition on patients in the ICU of a university hospital. In this study, a total of 100 patients who were under follow-up in the ICU for two years were examined. In our study, demographic characteristics, the reason for admission, comorbidity, initial ICU laboratory values, morbidity and mortality during the follow-up period of the patients who only received enteral nutrition (EN) or parenteral nutrition (PN) were evaluated, and the results between two were compared as well as evaluating the complications within the groups. The comparison of the reason for admission between the EN and PN groups showed that surgical reasons were significantly higher in the PN group. Nosocomial infections, the presence of infection and the development of sepsis were significantly higher in the EN group. The 28-day mortality rate was higher in the PN group compared to the EN group. The length of stay in the ICU and on mechanical ventilation was longer in the EN group. There was no significant difference in the 28-day mortality, readmission to the ICU and repeated endotracheal intubation between the two groups. Because there is no statistical difference between EN and PN groups in point of infection and mortality, we conclude that the length of stay in the ICU and reason for admission play a more crucial role in the development of infection and on mortality rather than enteral or parenteral nutrition route.

Biomarkers have been used in the diagnosis of disease and other conditions for many decades. There are diverse ranges of analytical targets, including metabolites, nucleic acids and proteins were used as a biomarker. Clinical diagnoses already rely heavily on these for patient disease classification, management, and informing treatment and care pathways. For that there is always a need of rapid and point of care test. However, until fairly recently, studies of biomarker efficacy in a clinical setting were mainly limited to single or dual use, and the landscape was complex, confused, and often inconsistent. Few candidates emerged from this somewhat clouded picture: C-reactive protein, procalcitonin (PCT) for sepsis, ADA for mycobacterium tuberculosis and a Circulating miRNAs serve as molecular markers for diverse physiological and pathological conditions.

Levosimendan is a calcium sensitizer and its inotropic effect is mainly attributed to the troponin C of the myocardial fine filaments with calcium. Levosimendan also inhibits phosphodiesterase III. In contrast to inotropic effects, this does not increase calcium entry into the cell, which explains that levosimendan does not worsen myocardial diastolic dysfunction and may even improve diastolic function. Levosimendan does not increase the use of myocardial oxygen and increases coronary vasodilation and myocardial oxygen delivery. Levosimendan opens potassium channels and causes hyperpolarization in smooth muscle cell membrane, thus causing vasodilatation [1]. Levosimendan has also been reported to have antiinflammatory [2,3] and antiapoptotic effects [2].

Retinopathy of prematurity (ROP) is a consequence of an arrest in normal retinal neural and vascular development, which determines the aberrant retinal regeneration [1,2]. ROP is a disease process mostly reported in preterm neonates ranging from mild, transient changes in the retina with regression to severe progressive vasoproliferation, scarring, detachment of retina and blindness and it is common blinding disease in children and a major cause of vision loss among preterm infants [3]. Today it is well known that oxygen therapy is not the single causative factor, but many other risk factors play a causative role in the pathogenesis of ROP [4,5]. The risk factors for ROP include oxygen administration, hypoxia, hypercapnia, blood transfusion exchange transfusion, apnea,sepsis and total parenteral nutrition. The incidence of ROP has been reported to be similar in multiple and singleton births [6-8]. Twin studies show that from 70% to 80% of the susceptibility to ROP is conditioned by genetic factors [9,10]. Hence this study is to find out the incidence of ROP in twins in a tertiary care centre in a developing country. It also attempts to identify the difference in risk factors among twins which predispose to ROP in Neonatal Intensive Care Unit.

Sepsis refers to a generalized inflammatory response of the organism to an infection or to bacterial products in circulation, rather than the development of an infection per se. Despite recent advances in clinical practice and overall medical care, sepsis remains a great health care problem and is still the most common cause of death in critically ill patients with infection. We suppose that during the course of sepsis the expression of TRAIL in different organs correlates with acute mortality and further development of multiple organ dysfunction syndrome (MODS). It is expected that dendritic cells (DCs) might become targets for apoptotic processes in a result of elevated TRAIL expression. This hypothesis is a bias for detailed investigations for in vivo studies in animal models and for in vitro studies of septic patients.

Background: Colorectal cancer progresses without any symptoms early on, or those clinical symptoms are very discrete and so are undetected for long periods of time. The case reported is an unusual presentation of colorectal cancer. Case Report: A 60 year old man presented with right sided abdominal swelling. On examination, a well-defined, firm, tender swelling was noted. Computed tomography confirmed the presence of a mass arising from the right colon with infiltration of the right lateral abdominal wall and adjacent collection. An exploratory laparotomy with drainage of the subcutaneous abscess, resection of ascending colon, and ileotransverse colon anastomosis was performed. Conclusion: A differential diagnosis of carcinoma colon should be considered when an elderly patient presents with abdominal wall abscess accompanied by altered bowel habits or per rectal bleeding, even if there are no other significant clinical symptoms and a thorough investigative work up is required to confirm the diagnosis, to avoid untimely delay in treatment, and reduce mortality.

The infectivity and pathogenesis: SARS-CoV-2, the causative agent of Covid-19, involves Angiotensin-converting enzyme 2 (ACE2) receptors on type II alveolar type 2 (AT2) cells in lungs. Apart from, the upper and lower respiratory tracts, the disease affects the gastrointestinal system prominently, as evidenced by the significant GI symptoms, early in the course of the disease. In addition, the virus infects ACE2-bearing cells in other organs including the heart and blood vessels, brain, and kidneys. Clinical features and morbidity: The clinical spectrum of COVID-19 varies from asymptomatic or pauci-symptomatic presentation to moderate to severe states characterized by respiratory failure necessitating mechanical ventilation and ICU support and those manifesting critical clinical condition with complications like sepsis, septic shock, and multiple organ dysfunction failure. The CT chest is an important tool for early identification of COVID-19 pneumonia as well as for prognostic purposes. The recovery and residual damage: The recovery and other outcomes vary depending on age and other aspects including sex, comorbidities, and genetic factors. The outlook for older adults, who account for a disproportionate share of critical disease, is unfavorable, and most of those who survive are unlikely to return to their previous level of functioning. The disease affects their long-term health and quality of life as well as brings in propensity for truncated post-disease survival. COVID-19 aftermath and follow up: The patients discharged from hospital following severe COVID-19, continue to suffer with lingering impact of the disease as well as that of the emergency treatments that saved their life. The post-infection reduced exercise tolerance and other subtle factors, like post viral fatigue syndrome, post-traumatic stress disorder, impaired concentration, delirium, and disturbed sleep-wake cycle often underly the functional impairment. In fact, there is need of step-down care and later a multidisciplinary support involving regular clinical assessment, respiratory review, physiotherapy, nutritional advice, and psychiatric support. Conclusion: The life after COVID-19: After recovery from the disease, the virus SARS-CoV-2, may persist for uncertain period. In addition, the chance of reinfection cannot be ruled out. The vitamin D supplementation may be helpful. In general, the quality of life (QOL) in ICU survivors improves but remains lower than general population levels, but most of the patients adapt well to their level of self-sufficiency and QOL. Also, the debility due to co-morbidities may further compromise the activity of daily living and QOL issues. The Age and severity of illness appear to be the major predictors of post-discharge physical functioning.

Introduction: Sepsis is an important cause of morbidity and mortality among neonates. Neonatal sepsis can alter the glucose level and both hypoglycemia and hyperglycemia may occur. A high or low blood glucose level may have a significant effect on the outcomes in patients of neonatal sepsis. Aims: The aim of the study to see the glycaemic status and its effect on outcome of neonatal sepsis. Material and Methods: This hospital based prospective observational cross-sectional study was conducted in Neonatal Intensive Care Unit in Universal College of Medical Sciences, a tertiary care hospital over a period of 4 months, from May 2019 to August 2019. A total of 220 Neonates suspected sepsis under the age of 28 days admitted in NICU, were studied and included in our study. Clinically suspected neonatal sepsis cases were enrolled in the study. Venous blood was collected before giving any intravenous fluid, dextrose or antibiotics and blood sugar, complete blood counts, CRP levels and blood culture were send to laboratory within half hour of collection. All patients included in this study were treated accordingly and followed up strictly. Blood glucose level and mortality of neonates having hypoglycemia, hyperglycemia were analyzed among CRP and culture positive patients. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage and comparison carried by Chi-square (χ2) test. Results: A total of 220 patients clinically diagnosed as neonatal sepsis were studied. 118 (53.6%) patients were found CRP positive and 56 (25.5%) patients were blood culture positive. Glycaemic status was analyzed among CRP and culture positive patients. Majority (55.9%) patients were found normoglycemic, 35.5% were found hypoglycemic and 8.6% were found hyperglycaemic in this study. 182 (82.73%) patients were cured and 38 (17.27%) died. Mortality was high in hypoglycaemic patients (34.4%) compared with normoglycaemic patients (9.82%), but the difference was not statistically significant (p > 0.05) between two groups, the mortality was high in hyperglycaemic patients (58.33%) compared with normoglycaemic patients (9.82%) and the difference was statistically significant (p < 0.05) between two groups. Conclusion: Alteration of glycaemic status occurred in septic newborn. Mortality is higher among the septic newborn with hyperglycemia. The present study found that majority of neonate with sepsis had high mortality rate when blood glucose level were either more than 145 mg/dl or less than 45 mg/dl. This signifies the importance of meticulous blood glucose estimation in cases of neonatal sepsis to improve mortality outcome.

A term neonate was transferred from a Local Neonatal Unit to our surgical Neonatal Intensive Care Unit on Day 2 due to abdominal distension with radiological appearances suggestive of intestinal obstruction. He was born by Caesarean section with no risk factors for sepsis. He was intubated at birth for increased work of breathing and failed planned extubation on Day 1. 

Background: Recent years have seen chaos in the neonatology use of antibiotics with diverse opinions and recommendations in international guidelines and societies. This has created great uncertainty in which cases to use, for how long, and which tests apply to make these decisions. We conducted a retrospective cohort study about the use of antibiotics in the EpicLatino neonatal units and a Latin American network database, after noting these variations in the 2019 report. Methods: For the year 2019 using the EpicLatino database, we included cases (only first admission) ≤ 32 weeks gestational age at birth, excluding one unit that did not accept to participate. The number of cases and days receiving antibiotics were recorded as well as the progression for each unit. Inappropriate use of antibiotics was defined as greater than 3 days in patients with negative cultures (blood/CSF cultures) excluding: major malformations, urinary tract infections, necrotizing enterocolitis (NEC) and cases with suspected chorioamnionitis in the mother (the latter two only during the course of diagnosis of NEC or chorioamnionitis). Results: A total of 6,543 days of antibiotics were observed, 49.5% of cases had at least one positive blood/CSF culture. A total of 595 days of antibiotics without justification were found in 72 courses in 61 cases: 19.4% had no diagnosis of infection in the database, 9.7% did not document any culture throughout their stay, and 51,4% obtained only one blood/CSF culture during their entire stay. In the 58 cases with diagnosis of infection: 41% were clinical sepsis and a diagnosis of pneumonia with a poor positive culture correlation was found. Furthermore, 74% of the unit’s didn´t use pneumonia as a justification to use antibiotics. Other diagnosis found: Conjunctivitis, NEC 1A and rotavirus NEC. Conclusion: Although the method of reviewing the use of antibiotics in a database has a number of limitations, especially the cause that motivated the use of antibiotics and other tools used for diagnosis of infections, the notable differences between units is striking. Although it is difficult to make recommendations to all units, it is important to control infections in some units and in others to reduce the excessive use of antibiotics, especially with diagnosis of pneumonia in neonates and negative blood/CSF cultures.

Despite critical care advances, robust antibiotic therapy and improved strategies in early detection and prevention of infection, the incidence of morbidity and mortality from neonatal sepsis worldwide in preterm and low birth weight neonates remains overwhelmingly high. Neonatal sepsis is characterised by a clinical syndrome of systemic signs of infection and bloodstream bacteraemia in newborns within the first months of life. The risk of sepsis in neonates is inversely proportional to gestational age and birth weight due to deficiency in humoral immunity and the need for more invasive supportive neonatal intensive care unit interventions. Adverse effects such as necrotising enterocolitis associated with antimicrobial therapy are serious enough to warrant exploration of alternative therapeutic strategies. Immunoglobulin replacement therapy offers hope of enhancing immune competence and reducing infection rates in vulnerable populations. It is evident from the relevant studies to date that the benefits offered by intravenous immunoglobulin prophylaxis may not be significant enough for routine hospital implementation. Further research to better understand the mechanisms underlying immunodeficiency will lead to the realisation of alternative therapeutic and prophylactic interventions.

Introduction: Sepsis remains a major cause of death in neonatal period. Although significant advances in diagnosis, therapeutic and prevention strategies have been noted, sepsis remains a common concern in clinical practice especially in low-resource countries. The aim of this study was to determine the predictors of mortality in neonatal sepsis in Lubumbashi city (Democratic Republic of Congo). Methods: The records of newborns with sepsis managed in Neonatal Intensive Care Units in two University Hospitals between November 2019 and October 2020 were studied. Binary and multiple logistic regressions have been used to observe the association between independent variables and dependent variable. Results: A total of 162 cases of neonatal sepsis were reviewed. The mortality rate of neonatal sepsis was 21% of babies admitted. Very low birth weight (< 1500 grams) and primiparity were significantly associated with mortality in neonatal sepsis (AOR = 12.66; 95% CI 2.40 to 66.86; p = 0.003 and AOR = 3.35; 95% Cl 1.31 to 8.59; p = 0.012, respectively). Conclusion: The mortality rate of neonatal sepsis was 21%. Very low birth weight and primiparity were significantly associated with mortality in neonatal sepsis.

Background: Sepsis among newborns is common and a major cause of neonatal deaths in developing countries. Annually, about 4 million neonatal deaths occur around the world. Of these, more than 30% are caused by infections majority of which start as umbilical cord infections. Topical umbilical cord care can reduce omphalitis (umbilical cord infection) and neonatal mortality among newborns.Objective: This study aimed to compare the incidence of omphalitis in different cord care interventions (Dry, Chlorhexidine, and Alcohol) in Nakuru County, Kenya. Methodology: A randomized controlled trial was carried out between July 2018 and June 2019. A total of 540 newborns were randomly assigned to receive 1 of 3 cord care regimens; twice cord cleansing with 4% chlorhexidine (Group 1), twice cord cleansing with 70% alcohol (Group 2), and dry cord care (Group 3) as control. Results: The risk of omphalitis was significantly reduced in the chlorhexidine group than in dry and alcohol cord care groups. The incidence of omphalitis was 1.95 times more likely to occur among the dry cord care group [AOR = 1.95; 95% CI = 1.13-3.38; p = 0.017] compared to the chlorhexidine group. Similarly, babies in the alcohol group were nearly 2 times more likely to develop omphalitis [AOR = 1.98; 95% CI = 1.15-33.40; p = 0.014] compared to those in the chlorhexidine group.Conclusion and recommendation: Chlorhexidine topical cord care significantly reduces the risk of umbilical infection in neonates when compared to both topical alcohol application and dry cord care approach. It should be recommended to be used topically for the prevention of omphalitis in our setup.

Introduction: The world is currently facing the SARS-CoV-2 pandemic with evolving 2nd wave. The COVID-19 patients present most commonly with Severe Acute Respiratory Illness (SARI) in an emergency room with acute onset fever, cough, and breathlessness. However, not all SARI cases as per definition are due to COVID-19 infection, which is well proven in this case series of 113 cases of SARI. This is just the opposite of the other SARI series done in the pre-COVID-19 era. Also, no previous SARI case series data has shown significant association with Diabetes Mellitus, including new-onset diabetes thus figuring out the major Pathophysiological association of COVID-19 with glucose metabolism and has a bearing on the pathogenesis, treatment, and outcome of COVID-19 infection and perpetuity of pandemic of this magnitude. Here we raise concern for the first time about the growing association of an infectious pandemic with the lifestyle disorders which are non-communicable diseases but carry with them the potential of fertile soil for rapidly spreading epidemics.Aim and objective: To find out the etiology, clinical profile, treatment outcome, and mortality rate in different sub-groups of SARI cases in a tertiary care hospital and the incidence of new-onset Diabetes Mellitus in them and to investigate theoretically the hypothesis that maintaining normal glucose metabolism could prevent progression of a mild Flu-like illness (FLI) to a severe form of Severe Acute Respiratory Illness (SARI) and consequent complications such as Cytokine Storm Syndrome and Multi-Organ failure.Design: Retrospective, single-center case series of 113 SARI patients at a tertiary care hospital in Agra India between 1 March- 30 October 2020.Main outcome: The demographics, clinical, pathological, imaging, and treatment outcome data were collected. The SARI cases analyzed were defined as “Severe acute respiratory infections (SARIs) an acute respiratory illness of recent onset (within seven days) manifested by fever (≥38°C), cough and shortness of breath or difficulty in breathing requiring hospitalization and were sub-classified according to the primary etiology producing SARI in them. The findings were compiled and compared. Conclusion: Of the 113 patients of SARI – 32.7 %were associated with Diabetes, with 9.74% new-onset Diabetes and 26 % previously known Diabetes. This was mainly due to SARS-CoV-2 (24 Diabetics out of 52 COVID-19 cases- 46.1 %).The Average hospitalization stay of SARI cases was 10 days with a maximum in SARS-CoV-2 and a minimum stay of 5.22 days in Bacterial Pneumonia and 5.66 days in Koch’s Lungs.The death rate was maximum (4 out of 26) 15.3%. Hospitalized TB/Koch’s Lung patients who presented as SARI and 3.8% in Bacterial Pneumonia, 2.43% in SARS-CoV-2, and <1% in Sepsis.Those SARI cases who were euglycemic at the time of initial presentation recovered early and carried a good prognosis with less mortality as compared to those who were hyperglycemic on presentation. Also, those FLI cases who maintained euglycemia or did not have any other risk factor which predisposes them to stress (Diabetes, Prolonged fasting, Obesity, major organ disorder, Psychological disorder, and Cancer) did not progress to SARI as the endogenous steroid secretion and sympathetic activation did not occur, the intracellular pH levels remained in the alkaline range.10.18% of cases developed new-onset diabetes (a total of 11 cases) out of which 10 were in COVID-19. Thus 19.2% incidence of new-onset diabetes in SARS-CoV-2 and a prevalence of 26.9% in SARS-CoV-2, making total diabetes 46.1% in SARS-CoV-2, and out of all SARI cases, 26 % of patients developed pulmonary fibrosis with consequent long-term complications. In COVID-19 patients, it was seen only in diabetics SARS CoV-2 male patients, thus no death in non-diabetic females in COVID-19 in this case series.

Neonatal sepsis is a systemic infection that causes high morbidity and mortality rates in newborns during the first month of life. Although there is abundant literature on the subject, it remains a fundamental public health problem due to its high prevalence in underdeveloped countries. This article aims to highlight the importance of the approach in investigating neonatal sepsis using causality research questions, which generate knowledge to promote better care and reduce the complications associated with neonatal sepsis in newborns.

Ms X is a 40-year-old gravida 12, para 2+9 woman, who was admitted for an elective caesarean section at 38 weeks gestation following the previous two caesarean sections. Ms X had abdominal distension and generalised abdominal tenderness in the postoperative period. On investigation, she was found to have an elevated white cell count (WCC), C - Reactive Protein (CRP) and creatinine with free fluid in the abdomen on imaging but there was no evidence of perforation of any visceral organ. Ms X was treated conservatively for sepsis, an Acute Kidney Injury (AKI) and post-operative ileus and her symptoms gradually resolved. This is a case of idiopathic ascites post caesarean delivery with no clear cause.

Introduction: Severe cases of COVID-19 presented a high incidence of multi-organ dysfunction syndrome (MODS) during their evolution. This was attributed to a theoretical cytokine storm, where microcirculatory disorders would play a fundamental role, causing these patients to present a sepsis-like pattern as observed in sublingual microcirculation studies. The evidence in this regard is controversial. The Peripheral Perfusion Index is a reliable method to continuously and non-invasively assess the microcirculatory bed, which assesses the pulsatile (PPI) component of the plethysmographic pulse curve.Methods: We conducted a prospective observational study to evaluate the behavior of the PPI in patients with severe respiratory failure due to SARS-CoV-2 and its association with SDOM.Results: We evaluated 60 patients with APACHE II 14.6 ± 4.4 and SOFA 4.7 ± 2.1. 55% of the patients presented SDOM. Perfusion monitoring showed IP values of 5.32 ± 1.87 that were associated with normal lactate levels of 1.49 mmol/L (min 0.89/ max 2.20 mmol/L). The PPI values between the living and the dead did not show a significant difference (p = 0.854) or the presence of SDOM.The PPI values between the patients who presented renal failure, hemodynamics, or perfusion disorders were determined by the presence of hyperlactatemia, and for those who did not present these characteristics, no statistical difference was found; neither when stratified by PaFiO2 ratio. Mortality was 55%.Conclusion: In our series of patients with severe pneumonia due to COVID-19, we found high PPI values, which would correspond to a pattern of capillary recruitment, and the associated organ injury could not be substantiated by this phenomenon.

Background: Factors like emotions, lifestyle choices, and physical activities, including posture changes, have a significant impact on cardiovascular indicators like blood pressure and heart rate. The study aims to examine the cardiovascular reactions in individuals with type 2 diabetes while performing the head-down crooked kneeling (HDCK) or Sujood position, resembling poses found in hatha yoga. This position emphasizes relaxation, body awareness, and meditation. Those with type 2 diabetes who engage in yoga have reported enhancements in their management of blood sugar levels and insulin resistance. Methodology:  A cross-sectional study was conducted in different hospitals. The sample size was 312 which was calculated by using the Rao soft calculator. The participants were selected by non-probability convenience sampling technique. Inclusion Criteria were male and Female diagnosed with Type 2 DM, Subjects with a history of smoking, Cognitive Impairment, Sepsis, Cardiac pathology, Respiratory disorders, and Malignancy were excluded. Blood pressure and heart rate were monitored initially, during the Crooked Down Kneeling position, and after the Crooked Down Kneeling Position. A Digital Sphygmomanometer was used to measure blood pressure and a pulse rate-demographic Assessment form was used to collect data. Ethical consideration is maintained. Informed consent was taken from participants. Results: The result shows a significant effect of head down crooked kneeling position on cardiovascular response in type 2 diabetic patients (p < .001). Systolic, diastolic blood pressure, and heart rate before, during, and after HDCK were significantly increased (p < .001) as compared to the baseline value, and after 5 min returning to the upright position it reverted to the initial value. Conclusion: This study revealed a significant increase in systolic and diastolic blood pressures and an increase in pulse rate during HDCK. Also, our findings showed no significant gender difference in the effect of HDCK on all the other cardiovascular parameters except systolic bp.

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section.Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications.Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017.An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded.Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%.  Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%.Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency.