title: Case series of multiple repeat caesarean sections: operative, maternal, and neonatal outcome.
abstract: OBJECTIVE
  The objective of this study is to review the maternal and neonatal morbidity and mortality associated with six or more caesarean section (CS).
  
  
  METHODS
  We conducted a retrospective chart review, at King Abdulaziz University Hospital (KAUH) in Jeddah, for all patients admitted between 2000 through 2010 and identified five patients having more than six CS deliveries.
  
  
  RESULTS
  Deliveries occurred in the ranges of 31-38 weeks, from which four cases required emergency CS. There were two cases in the series with a placenta previa. There was a single case of uterine dehiscence. Only one case required a blood transfusion and was complicated with a placenta accreta, bladder injury, urinary tract infection, and prolonged maternal hospital stay with neonatal intensive care unit (NICU) admission. All cases had moderate to severe adhesion intra-operatively. Operative time was long in all cases with a range 55-106 min. One of the five cases had a postoperative wound infection. Finally, none of the current series showed fetal or maternal mortalities.
  
  
  CONCLUSIONS
  The long-term complications associated with CS should be discussed with patients in the first and subsequent pregnancies. This case series highlighted the outcomes in these unique cases of higher order caesareans.
authors.affiliation: a Department of Obstetric and Gynecology , Faculty of Medicine, King Abdulaziz University Hospital , Jeddah , Saudi Arabia .|b The Ottawa Hospital Research Institute (OHRI), University of Ottawa , Ottawa , Canada .|c Obstetrics and Maternal Newborn Investigation Research Group (OMNI) , Ottawa , Canada .|d Department of Obstetrics , Gynecology and Newborn Care-The Ottawa Hospital, University of Ottawa , Ottawa , Canada .
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alnoman
authors.affiliation: e Better Outcomes & Registry Network (BORN) , Ottawa , Canada .|f School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa , Ottawa , Canada .|g Department of Public Health Sciences , Karolinska Institute , Karolinska , Sweden , and.|h Global Health Program, l'Université du Québec en Abitibi-Témiscamingue (UQAT) , Quebec , Canada.
authors.forename: Ziad
authors.initials: Z
authors.lastname: El-Khatib
authors.affiliation: a Department of Obstetric and Gynecology , Faculty of Medicine, King Abdulaziz University Hospital , Jeddah , Saudi Arabia .
authors.forename: Ahmad M S
authors.initials: AM
authors.lastname: Almrstani
authors.affiliation: b The Ottawa Hospital Research Institute (OHRI), University of Ottawa , Ottawa , Canada .|c Obstetrics and Maternal Newborn Investigation Research Group (OMNI) , Ottawa , Canada .|d Department of Obstetrics , Gynecology and Newborn Care-The Ottawa Hospital, University of Ottawa , Ottawa , Canada .|e Better Outcomes & Registry Network (BORN) , Ottawa , Canada .
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
authors.affiliation: b The Ottawa Hospital Research Institute (OHRI), University of Ottawa , Ottawa , Canada .|d Department of Obstetrics , Gynecology and Newborn Care-The Ottawa Hospital, University of Ottawa , Ottawa , Canada .|e Better Outcomes & Registry Network (BORN) , Ottawa , Canada .
authors.forename: Darine
authors.initials: D
authors.lastname: El-Chaar
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D011247:Pregnancy; D012086:Reoperation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology
keywords: Cesarean sections; complications; maternal and neonatal; multiple; outcome