Outcome after a high number (4–10) of repeated caesarean sections

Juntunen, Kaisa; Mäkäräinen, Leo; Kirkinen, Pertti

doi:10.1111/j.1471-0528.2004.00154.x

Cited by 48 publications

(49 citation statements)

References 9 publications

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“…As stated previously, the incidence of adhesion development increases with the number of CDs performed. 12,13 Similar finding was reported by Juntunen and colleagues 64 who reported a significantly higher risk of intraperitoneal adhesions in patients undergoing their 4th to 10th CD compared to those having their 1st, 2nd, or 3rd CD (OR, 8.1; CI, 2.7-23.8).…”

Section: Clinical Evidence Of a Lower Prevalence Of Adhesions Followisupporting

confidence: 81%

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

et al. 2011

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In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.

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Section: Clinical Evidence Of a Lower Prevalence Of Adhesions Followisupporting

confidence: 81%

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

et al. 2011

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“…Juntunen and colleagues reported a significantly higher percentage of thin (<2 mm) lower uterine segment in patients undergoing repeat LSCS. 13 Therefore, incomplete healing of the low transverse uterine incision as determined by transvaginal ultrasound may occur more frequently than earlier thought. In present study the thinned out LUS (1 caesarean section vs 2caesarean section -21.13 vs 36.17% respectively).…”

Section: Thin Lower Uterine Segmentmentioning

confidence: 89%

A study of intra-operative maternal morbidity after repeating caesarean section

Somani¹,

Sudhir²,

Somani³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.

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“…Higher order caesarean section outcome data have come mainly from hospital-based retrospective case analyses outside of the UK. [8][9][10][11] One cohort study 12 examined the outcomes of caesarean section relative to the number of previous caesareans. This study only included elective caesarean sections undertaken in selected tertiary units and, as such, may represent a biased sample.…”

Section: Introductionmentioning

confidence: 99%

Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study

Cook

Jarvis

Knight

et al. 2012

BJOG

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Objective To estimate the incidence of multiple repeat caesarean section (MRCS) (five or more) in the UK and to describe the outcomes for women and their babies relative to women having fewer repeat caesarean sections.Design A national population-based prospective cohort study using the UK Obstetric Surveillance System (UKOSS).Setting All UK hospitals with consultant-led maternity units. Methods Prospective cohort and comparison identification through the UKOSS monthly mailing system.Main outcome measures Incidence, maternal and neonatal complications. Relative risk, unadjusted (OR) and adjusted (aOR) odds ratio estimates.Results The estimated UK incidence of MRCS was 1.20 per 10 000 maternities [95% confidence interval (CI), 0.97-1.47]. Women with MRCS had significantly more major obstetric haemorrhages (>1500 ml) (aOR, 18.6; 95% CI, 3.89-88.8), visceral damage (aOR, 17.6; 95% CI, 1.85-167.1) and critical care admissions (aOR, 15.5; 95% CI, 3.16-76.0), than women with lower order repeat caesarean sections. These risks were greatest in the 18% of women with MRCS who also had placenta praevia or accreta. Neonates of mothers having MRCS were significantly more likely to be born prior to 37 weeks of gestation (OR, 6.15; 95% CI, 2.56-15.78) and therefore had higher rates of complications and admissions.Conclusions MRCS is associated with greater maternal and neonatal morbidity than fewer caesarean sections. The associated maternal morbidity is largely secondary to placenta praevia and accreta, whereas higher rates of preterm delivery are most likely a response to antepartum haemorrhage.Keywords Multiple repeat caesarean section, placenta praevia, postpartum haemorrhage.Please cite this paper as: Cook J, Jarvis S, Knight M, Dhanjal M. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG 2013;120:85-91.

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Outcome after a high number (4–10) of repeated caesarean sections

Cited by 48 publications

References 9 publications

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

A study of intra-operative maternal morbidity after repeating caesarean section

Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study

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