title: Multiple repeat caesarean sections: complications and outcomes.
abstract: OBJECTIVE
  To compare the complications and outcomes of Caesarean section (CS) in women who have had three or more previous lower segment Caesarean sections with those in women with one previous CS.
  
  
  METHODS
  We performed a retrospective study of 371 patients undergoing repeat CS. Of these, 115 (31%) had previously had three or more Caesarean sections (group 1) and 256 (69%) had previously had one CS (group 2). All 371 patients had the repeat CS performed at Abha Maternity Hospital, Saudi Arabia between June 2002 and May 2004. Demographic data, complications, and outcomes were compared using the Student t and chi-square tests.
  
  
  RESULTS
  There were statistically significant differences between the two groups with respect to mean maternal age, parity, gestation at delivery, and experience of the surgeon (P < 0.05). CS was performed as an emergency in 38 (32.9%) and 186 (72.6%) of patients in groups 1 and 2 respectively (P < 0.05). The consultant was involved in the decision to perform CS in 215 (84.6%) of patients with one previous CS. There were significant differences between the two groups in the type of skin incision, the presence of dense adhesions during surgery, and bladder injury (P < 0.05). There were no statistically significant differences in birth weight, stillbirth rate, low Apgar score, blood loss during surgery, duration of surgery, or the duration of postoperative hospital stay.
  
  
  CONCLUSIONS
  The prevalence of dense intra-abdominal adhesions and of bladder injury during CS was higher in women with a history of three or more previous CS than in women with one previous CS. Placenta previa and Caesarean hysterectomy occurred with equal frequency in each group, and wound dehiscence and uterine rupture were rare.
authors.affiliation: Department of Obstetrics and Gynaecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia.
authors.forename: Adekunle
authors.initials: A
authors.lastname: Sobande
authors.affiliation: Department of Obstetrics and Gynaecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia.
authors.forename: Mamdoh
authors.initials: M
authors.lastname: Eskandar
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies