Evaluation of maternal morbidity in association with multiple repeated lower segment cesarean sections [more than four]

ABSTRACT

To determine the safety of repeated multiple caesarean sections more than four by comparing the outcome to a control group with lower number of repeated caesarian sections. Study design: A retrospective case-control study. Department of OB/GYN, women's health Hospital, Assiut University, Assiut, Egypt. Fifty patients who had previous four caesarian sections or more were compared to another control group of 50 patients who had lower number of repeated caesarian sections, as regards potential intra and post operative complications; including duration of surgery, degree of adhesion and possible adjacent organ injury. Also; dehiscence or rupture scar; blood transfusion and intensive care unit [ICU] admission were reported. in the study group [>/= 4 previous caesarian sections] the operative and hospital stay time were significantly longer with a higher rate of infra-operative adhesions, ileus and bladder injury than control group. The incidence of abnormal placentation [placenta accrete], caesarian hysterectomy and the need for blood transfusion was higher than that of the control group. There was no significant difference in postoperative complications or ICU admission. The neonatal outcome was comparable in the two groups and there was no maternal or fetal mortality. multiple repeated lower segment caesarian sections >/= 4 appears to be associated with higher rate of serious complications, so such patients must be advised to have the surgery in a tertiary obstetric care center with satisfactory facilities including a blood bank and adult as well as neonatal intensive care units. Also counseling about sterilization should be offered