Background: As with all types of abdominal surgeries, a Caesarean section is associated with risk of anesthesia, intra operative risks like blood loss requiring blood transfusion due to various causes like adhesions, extension of uterine incision, adherent placenta. Present study was aimed to study intra-operative difficulties in repeat cesarean sections with special reference to complications at a tertiary care hospital. Material and Methods: Present study was descriptive study, conducted in women undergoing who undergone-section during this pregnancy who had one / more cesarean section in her previous deliveries irrespective of age and parity. Results: Mean age was 27.65± 2.78 years. Most of them have complains of Severe abdominal pain (68.97%) followed by PV leaking or PV bleeding (25.86%) and Postdated pregnancy (24.14%). Scar tenderness (41.38%) is the leading cause of repeat C-section followed by Oligohydramnios (18.10%). Also, leaking PV and bleeding PV (3.45%) are contributing factors for repeat C-section. Most difficult among the procedure is approach to lower segment (44%) followed by opening of abdomen in layers (37%) and uterine closure (24.16%) in such patients. Majority of the patients do not have any complication (55.17%). Maximum no. of complications encountered were Hemorrhage (34%), followed by Thinned out lower segment (13%) and Adhesions (18%). Presence of adhesion does not increase need of extension of uterine incision (p = 0.952). Approach to lower segment is associated with the adhesion, a complication of previous LSCS (p = 0.0010). Adhesion makes it difficult to approach to lower uterine segment. Exteriorization of uterus is very strongly associated with the adhesion due to previous C-section (p < 0.001). Conclusion: Abdominal pain along with Scar tenderness can be used as guiding tool to anticipate presence of Adhesion. Intra-abdominal adhesions occur more frequently after C-sections