Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome.
OBJECTIVE
To determine maternal/neonatal complications and outcome in patients with multiple repeat cesarean sections (CSs).


METHODS
A retrospective case-control study of 144 pregnant women with > or = 4 cesarean sections was compared with a control group of 288 women having 2-3 cesarean sections for maternal, operative and neonatal complications.


RESULTS
The study patients had longer operating times (p = 0.0001) due to severe adhesions (p = 0.0005), with increased blood loss and blood transfusion (p = 0.0001). Rupture of the uterus (p = 0.0015), placenta previa (p = 0.0372), gestational age at delivery (p < 0.0002), preterm birth (p = 0.0497) and Apgar scores < 7 at 5 minutes (p = 0.0140) were significant in the study group. There was no significant difference of placenta accreta, bladder and bowel injury, cesarean hysterectomy, wound infection and postoperative pyrexia between the 2 groups. Among the neonates of the 2 groups, NICU admissions, small-for-gestational-age birth weights, large-for-gestational-age birth weights and perinatal mortality were similar. No mother died in the series. The incidence of a single major complication was higher in women with > or = 4 cesarean deliveries (p = 0.0011).


CONCLUSIONS
Repeated CS increases the risk of uterine rupture and intraoperative complications, making these patients a high-risk group. No absolute upper limit for the number of repeat cesarean deliveries can be given. Patients must be informed of the risks of multiple CSs and encouraged to have tubal ligation.
Department of Obstetrics and Gynecology, Dammam University College of Medicine, 31952 Al Khobar, Saudi Arabia.
Turki
T
Gasim
Fathia E
FE
Al Jama
Mohammad Sayedur
MS
Rahman
Jessica
J
Rahman
D000328:Adult; D001724:Birth Weight; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016022:Case-Control Studies; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015931:Intensive Care, Neonatal; D007431:Intraoperative Complications / Q000453:epidemiology*; D054238:Perinatal Mortality; D010923:Placenta Previa / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications; D014597:Uterine Rupture / Q000453:epidemiology