title: Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases.
abstract: OBJECTIVE
  To evaluate the maternal and neonatal risk related with multiple repeated cesarean sections.
  
  
  METHODS
  A case control study was conducted in a single tertiary maternity and children's center. The outcome of a study group including 122 pregnant women undergoing cesarean section for the fourth or fifth time was compared with a control group comprising 146 women sectioned for the second and third time. All multiple repeated cesarean sections were divided into urgent and elective groups to compare the outcome measures of demographic, neonatal, intra- and post-operative data.
  
  
  RESULTS
  Compared with the control group, the study group had significantly lower birth weights (p=0.026), lower Apgar scores at 1 minute (p=0.0001) and 5 minutes (p=0.042), higher numbers of fetal death (p=0.03), higher rate of omentum adhesions (p =0.0001) and peritoneal adhesions (p=0.008), increased risk of cesarean hysterectomy (p = 0.014), increased need for transfusion (p = 0.018), and an increase in hospitalization days (p=0.005). Compared with the elective group, preterm birth incidence was higher (p = 0.01) and birth weight was lower (p=0.004) in the urgent group. The risk for myometrium herniation (p=0.018), need for drainage during operation (p=0.018), and post-operative fever (p =0.001) was also more common in the urgent group.
  
  
  CONCLUSIONS
  Multiple repeated cesarean sections increase the risks for operative complications and poor perinatal outcomes. Patients must be informed about the related risks of multiple repeated cesarean sections and tubal ligation needs to be encouraged.
authors.affiliation: Department of Obstetrics and Gynecology, Istanbul Bakirkoy Maternity and Children Diseases Hospital, Istanbul, Turkey. alged_1971@yahoo.com
authors.forename: Ali
authors.initials: A
authors.lastname: Gedikbasi
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Akyol
authors.forename: Banu
authors.initials: B
authors.lastname: Bingol
authors.forename: Demet
authors.initials: D
authors.lastname: Cakmak
authors.forename: Akif
authors.initials: A
authors.lastname: Sargin
authors.forename: Remzi
authors.initials: R
authors.lastname: Uncu
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Ceylan
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D001803:Blood Transfusion; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004638:Emergency Treatment / Q000009:adverse effects; D005260:Female; D005313:Fetal Death; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D009852:Omentum / Q000473:pathology; D010298:Parity; D010537:Peritoneum / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000473:pathology