title: Multiple cesarean section. The impact on maternal and fetal outcome.
abstract: OBJECTIVE
  To evaluate the complications, and to determine maternal and fetal risks in women who undergo 3 or more cesarean sections (CS), compared to those with one or 2 cesarean deliveries.
  
  
  METHODS
  A retrospective analysis of 2276 CS performed between 1 January 2003 and 31 April 2005. We divided patients into 3 groups: Group 1 = with 1 previous CS (n=1183); Group 2 = 2 previous CS (n=781); and Group 3 = >3 previous CS (n=312).
  
  
  RESULTS
  Compared to women with one or 2 cesarean deliveries, women who had >3 CS show significant increase in terms of prolonged operative time, uterine scar dehiscence, uterine rupture, placenta previa, placental adherence, and mild adhesion formation. We found no significant differences between the 3 study groups in terms of injury to surrounding structures, need for blood transfusion, anesthesia complications, hematoma formation, thromboembolism, and incisional hernia. Apgar score >7 at one and 5 minutes, neonatal intensive care unit, multiple pregnancy rate, premature delivery rate and perinatal death rate, all were similar in the 3 groups.
  
  
  CONCLUSIONS
  Women with multiple CS (>3) are significantly prone to have uterine scar rupture and abnormal placentation in the subsequent pregnancies compared to those with one or 2 previous cesarean deliveries. Despite that, maternal and neonatal outcome did differ from patients with lower-order cesarean sections.
authors.affiliation: Department of Obstetrics and Gynecology, Prince Rhashed Hospital, Irbid-Aidoun, Jordan. hqublan@yahoo.com
authors.forename: Hussein S
authors.initials: HS
authors.lastname: Qublan
authors.forename: Yousef
authors.initials: Y
authors.lastname: Tahat
mesh_terms: D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies