Multiple cesarean section. the impact on maternal and fetal outcome

ABSTRACT

To evaluate the complications, and to determine maternal and fetal risks in women who undergo 3 or more cesarean sections [CS], compared to those with one or 2 cesarean deliveries. A retrospective analysis of 2276 CS performed between 1 January 2003 and 31 April 2005. We divided patients into 3 groups Group 1 = with 1 previous CS [n=1183]; Group 2 = 2 previous CS [n=781]; and Group 3 = >3 previous CS [n=312]. Compared to women with one or 2 cesarean deliveries, women who had >3 CS show significant increase in terms of prolonged operative time, uterine scar dehiscence, uterine rupture, placenta previa, placental adherence, and mild adhesion formation. We found no significant differences between the 3 study groups in terms of injury to surrounding structures, need for blood transfusion, anesthesia complications, hematoma formation, thromboembolism, and incisional hernia. Apgar score >7 at one and 5 minutes, neonatal intensive care unit, multiple pregnancy rate, premature delivery rate and perinatal death rate, all were similar in the 3 groups. Women with multiple CS [>3] are significantly prone to have uterine scar rupture and abnormal placentation in the subsequent pregnancies compared to those with one or 2 previous cesarean deliveries. Despite that, maternal and neonatal outcome did differ from patients with lower-order cesarean sections