title: Impact of multiple cesarean deliveries on maternal morbidity: a systematic review.
abstract: OBJECTIVE
  The purpose of this study was to determine the impact of increasing numbers of cesarean deliveries on maternal morbidity. This study was performed for the 2010 National Institutes of Health Consensus Development Conference on Vaginal Birth After Cesarean: New Insights.
  
  
  METHODS
  We conducted a systematic review and metaanalysis of observational studies.
  
  
  RESULTS
  Twenty-one studies (2,282,922 deliveries) were included. The rate of hysterectomy, blood transfusions, adhesions, and surgical injury all increased with increasing number of cesarean deliveries. The incidence of placenta previa increased from 10/1000 deliveries with 1 previous cesarean delivery to 28/1000 with ≥3 cesarean deliveries. Compared with women with previa and no previous cesarean delivery, women with previa and ≥3 cesarean deliveries had a statistically significant increased risk of accreta (3.3-4% vs 50-67%), hysterectomy (0.7-4% vs 50-67%), and composite maternal morbidity (15% vs 83%; odds ratio, 33.6; 95% confidence interval, 14.6-77.4).
  
  
  CONCLUSIONS
  Serious maternal morbidity progressively increased as the number of previous cesarean deliveries increased.
authors: Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA. marshani@ohsu.edu
authors: Nicole E
authors: NE
authors: Marshall
authors: Rongwei
authors: R
authors: Fu
authors: Jeanne-Marie
authors: JM
authors: Guise
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011247:Pregnancy; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean