Maternal morbidity associated with multiple repeat cesarean deliveries.
OBJECTIVE
Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.


METHODS
Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002).


RESULTS
There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.


CONCLUSIONS
Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.


METHODS
II-2.
Silver
Robert M
RM
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. Bob.Silver@hsc.utah.edu
Landon
Mark B
MB
Rouse
Dwight J
DJ
Leveno
Kenneth J
KJ
Spong
Catherine Y
CY
Thom
Elizabeth A
EA
Moawad
Atef H
AH
Caritis
Steve N
SN
Harper
Margaret
M
Wapner
Ronald J
RJ
Sorokin
Yoram
Y
Miodovnik
Menachem
M
Carpenter
Marshall
M
Peaceman
Alan M
AM
O'Sullivan
Mary J
MJ
Sibai
Baha
B
Langer
Oded
O
Thorp
John M
JM
Ramin
Susan M
SM
Mercer
Brian M
BM
D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D016015:Logistic Models; D009017:Morbidity; D016017:Odds Ratio; D010921:Placenta Accreta / Q000453:epidemiology; D010923:Placenta Previa / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D014219:Trial of Labor