title: Maternal complications associated with multiple cesarean deliveries.
abstract: OBJECTIVE
  The claim that a planned repeat cesarean delivery is safer than a trial of labor after cesarean may not be applicable to women who desire larger families. The aim of this study was to assess maternal complications after multiple cesarean deliveries.
  
  
  METHODS
  The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group).
  
  
  RESULTS
  Excessive blood loss (7.9% versus 3.3%; P < .005), difficult delivery of the neonate (5.1% versus 0.2%; P < .001), and dense adhesions (46.1% versus 25.6%; P < .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004).
  
  
  CONCLUSIONS
  Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number.
  
  
  METHODS
  II-2.
authors.affiliation: Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel. vnisenblat@gmail.com
authors.forename: Victoria
authors.initials: V
authors.lastname: Nisenblat
authors.forename: Shlomi
authors.initials: S
authors.lastname: Barak
authors.forename: Ofra Barnett
authors.initials: OB
authors.lastname: Griness
authors.forename: Simon
authors.initials: S
authors.lastname: Degani
authors.forename: Gonen
authors.initials: G
authors.lastname: Ohel
authors.forename: Ron
authors.initials: R
authors.lastname: Gonen
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D014219:Trial of Labor