Major risk factors of maternal adverse outcome in women with two or more previous cesarean sections

Egić, Amira; Karadžov-Orlić, Nataša; Mojovic, Donka; Milovanović, Zagorka; Vuceljic, Jovana; Krsmanović, Suzana

doi:10.2298/vsp150428055e

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…CD as a reference group, as such it is difficult to seek conclusions specifically on the group of low order repeat CD [8,13,[16][17][18][19][20]. As summarized in Table 5, most studies were retrospective, compared between low and high order CD on various outcomes, including maternal complications, focusing mainly on the effect of the order of CD [8,13,[16][17][18][19].…”

Section: Plos Onementioning

confidence: 99%

Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study

et al. 2023

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One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005–2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.

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Section: Plos Onementioning

confidence: 99%

Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study

et al. 2023

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Maternal and Fetal Outcomes after Multiple Cesarean Deliveries

Muñoz-Saá,

Sendra,

Carriles

et al. 2024

JCM

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Background/Objectives: Cesarean delivery (CD) is a common procedure, but it can be associated with some increasing risks as the number of previous CD increases. Although women undergoing multiple CDs is very unusual in Spain, our center serves pregnant women with a history of three or more previous CDs with some frequency. We aimed to assess whether women who undergo multiple CDs (≥4) have more risks than those who undergo a third CD. Material and Methods: A retrospective cohort study was conducted with 161 pregnant women who had undergone ≥ 2 previous CDs and were monitored during their next pregnancy. The primary endpoint was to evaluate the obstetric hemorrhage rate in the multiple CD group and compare it with that in the third CD group. Secondary outcomes regarding maternal and neonatal complications were also analyzed. Results: Hemorrhage (7% and 10%; p = 0.522) and transfusion (3% and 8%; p = 0.141) rates were similar in both groups. The risk of dehiscence of the uterine segment (6% and 24%; p < 0.006), as well as hysterectomy (0 and 6.6%, p = 0.019), difficult abdominal opening (49% and 82%; p = 0.001), peritoneal adhesions (3% and 22%; p < 0.001), and difficult bladder separation (36% and 73%; p < 0.001), was higher in the multiple CD group. No uterine rupture or maternal-neonatal mortality was observed in either of the groups. Conclusions: Since undergoing multiple CD is uncommon, our study may be the largest sample in our environment. Our findings suggest that despite the potential risks of undergoing multiple CDs, maternal and neonatal outcomes are overall favorable.

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Major risk factors of maternal adverse outcome in women with two or more previous cesarean sections

Cited by 2 publications

References 21 publications

Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study

Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study

Maternal and Fetal Outcomes after Multiple Cesarean Deliveries

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