Effect of Multiple Repeat Cesarean Sections on Maternal Morbidity: Data from Southeast Turkey

Abstract

BackgroundCesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity.Material/MethodsA total of 2460 patients who underwent delivery by CS at a center in southeast Turkey between January 2012 and January 2014 (24 months) were included in the study. The patients were divided into 5 groups according to the number of CSs, and the maternal and neonatal outcomes of the groups were retrospectively evaluated.ResultsA statistically significant difference was found between the groups in terms of maternal age, education level, time of hospitalization, operating time, the presence of dense adhesions, bowel and bladder injury, the presence of placenta previa, hysterectomy, blood transfusion requirements, and need for intensive care (p<0.05). Placenta previa (OR, 11.7; 95% CI, 2.6–53.2) and placenta accreta (OR, 12.2; 95% CI, 3.9–37.8) were found to be important risk factors in terms of the need for hysterectomy. No statistically significant difference was found between the groups for gestational age at birth, birth weight, fifth-minute APGAR score, preoperative and postoperative hemoglobin levels, uterine rupture, wound infection, wound dehiscence, placenta accreta, maternal death, and endometritis (p>0.05). A total of 4 or more CSs was identified as the critical level for most of the major complications.ConclusionsAn increasing number of CSs is accompanied by serious maternal complications. Four or more CSs are of especially critical importance. Decreasing the number of cesarean sections is required to decrease relevant complications. Vaginal birth after CS is an option that should be recommended to the patient.

Repeat cesarean section in subsequent gestation of women from a birth cohort in Brazil

“…Women with multiple cesarean sections are at higher risk of large adherences, intestinal and bladder lesions, abnormal placental implantation, hysterectomy, blood transfusion, and intensive care unit admission [24], which shows this procedure is not free of risk and that it must, therefore, have clear and precise medical indications.…”

“…Repeat cesarean sections may lead to increased risk of obstetrical complications such as large adherences, intestinal and bladder lesions, abnormal placental implantation, hysterectomy, blood transfusion, and intensive care unit admission [24], which may impact the reproductive future of those women.…”

Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study

“…Both vaginal delivery after cesarean and repeat cesarean delivery (RCS) are associated with maternal complications [9][10][11][12][13]. Risk of most maternal complications increases proportionally to the number of cesarean sections [14,15]. Whether or not trail of labor after two cesarean sections (TOLAC-2) increases neonatal mortality is still to be established.…”

Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience

“…In Turkey, the cesarean section (CS) rate increased from 8% to 37% between 1993 and 2008. 1 CS is a surgical procedure including some risks such as uterine rupture, infection, hemorrhage, thrombosis and damage to the bladder, ureters or bowel. 2 Although CS is now safe along with devolopments in anesthesia and surgery, these complications of CS can be life-threatening for both mother and baby.…”