Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity?

OBJECTIVE: The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity. METHODS: MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files. RESULTS: The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture. CONCLUSIONS: According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Maternal plasma prolidase, matrix metalloproteinases 1 and 13, and oxidative stress levels in pregnancies complicated by preterm premature rupture of the membranes and chorioamnionitis.

OBJECTIVE: This study aimed to investigate the role of various biochemical markers in preterm premature rupture of membranes (PPROM) and in prediction of chorioamnionitis in patients with PPROM. MATERIAL AND METHODS: This case-control study included a total of 100 pregnant women at 26-34 gestational weeks. Of these women, 50 were healthy and 50 had PPROM. The biochemical markers in the maternal plasma including prolidase, matrix metalloproteinase (MMP) 1 and 13, total oxidative status (TOS), total antioxidant capacity (TAC), glutathione peroxidase (GPx), catalase (CAT), paraoxonase-1 (PON-1), tumor necrosis factor alpha (TNF-α), and high sensitive C-reactive protein (hs-CRP) were assayed. These levels were compared between the PPROM and control groups and between women with or without chorioamnionitis in the PPROM group. RESULTS: Compared to the control group, the levels of prolidase, MMP-13, and TOS were significantly higher (p values <0.001, 0.020, and 0.035, respectively) and those of TAC and PON-1 were significantly lower in the maternal plasma of the PPROM group (p values=0.012 and <0.001, respectively). The plasma prolidase and TOS levels were significantly higher (p values=0.033 and 0.005, respectively) and the plasma TAC and PON-1 levels were significantly lower in women with chorioamnionitis as compared with the corresponding values in women without chorioamnionitis in the PPROM group (p values =0.041 and 0.048, respectively). The multivariate logistic regression analysis observed that prolidase, TAC, and PON-1 were important markers for the presence of PPROM and prolidase and TOS were important markers for predicting chorioamnionitis. CONCLUSION: This study suggested that maternal plasma prolidase, TAC, and PON-1 may be useful for the diagnosis of PPROM, and prolidase and TOS may be used to predict chorioamnionitis in patients with PPROM.