title: Intra-operative complications increase with successive number of cesarean sections: Myth or fact?
abstract: OBJECTIVE
  To determine whether complications related to surgery increase with increasing number of cesarean sections (CSs) in upper segment placenta. To compare the complications in urgent and elective high order (4-6) repeat CSs.
  
  
  METHODS
  A retrospective analysis of 519 women who underwent repeat CS was performed from January to December 2012. Women were divided into 3 groups: group 1 with previous 3 CS (n=325), group 2 with previous 4 CS (n=139), and group 3 with previous ≥5 CS (n=55).
  
  
  RESULTS
  Statistically significant differences (P < 0.001) were observed among 3 groups, regarding mean gravidity, type of CS, midline incision and bilateral tubal ligation performed. The risks of severe intra-peritoneal adhesions, thin out lower uterine segment and bladder injury were significantly increased (P < 0.001) with increasing number of CS deliveries. Only one cesarean hysterectomy was done in group 1 due to post partum hemorrhage. No significant differences were found in blood loss, duration of surgery, post operative hospital stay as well as birth weight and Apgar scores of newborns. The elective and emergency CS groups of high order repeat CS had no remarkable differences in operative, post operative complications and fetal outcome.
  
  
  CONCLUSIONS
  Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.
authors.affiliation: Department of Obstetrics and Gynecology, King Khalid University Abha College of Medicine, Abha, Kingdom of Saudi Arabia.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Zia
authors.affiliation: Department of Pediatrics, King Khalid University Abha College of Medicine, Abha, Kingdom of Saudi Arabia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rafique
keywords: Fetal outcome; Intra-operative complications; Multiple cesarean sections; Pregnancy outcome