Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries?

Abstract

Objective: To compare surgical complications and maternal and neonatal outcomes of low-risk, late preterm and term pregnant women who have had one or two previous cesarean sections (CSs) with those who have had three or more CSs.
 Methods: We conducted a retrospective study of 850 patients undergoing repeat CS at a tertiary level maternity hospital in Ankara, Turkey. Of those, 380 had previously undergone one or two CSs (Group-I: second or third CS) and 470 had previously undergone three or four CSs (Group-II: fourth or fifth CS). Outcomes and complications were compared between the groups.
 Results: The two groups were statistically significantly different in terms of maternal age, parity, body mass index, maternal weight gain during pregnancy, and length of hospital stay (all p<0.001). Although the prevalence of intraperitoneal adhesions and placenta previa was higher in Group-II than in Group-I (p<0.001), there was no statistically significant difference in terms of cesarean hysterectomy and adjacent organ injuries (p>0.05). There were also no significant differences between the groups in terms of neonatal outcomes (p>0.05).
 Conclusion: Although the increase in the number of CSs appears to be associated with intraperitoneal adhesions and placenta previa, adverse maternal and neonatal outcomes were not observed in those women with low-risk pregnancies who underwent CS for the fourth or fifth time. Therefore, fourth and fifth CSs may be considered relatively safe surgical procedures in this cohort.
 How to cite this:Hancerliogullari N, Yaman S, Aksoy RT, Tokmak A. Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries? Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.364
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gestación ectópica sobre cicatriz de cesárea

“…Parece claro que la cesárea aumenta su incidencia, pero, por el contrario, las cesáreas reiterativas no parecen aumentar este riesgo (9,10) . Además, se han propuesto otros factores de riesgo como otras cirugías uterinas previas (legrado uterino, ablación endometrial), extracción manual de placenta, técnicas de fecundación in vitro (11) .…”

“…El riesgo de recidiva de EESCC es bajo, entre 3 y 5% (9) . A pesar del escaso riesgo de recurrencia, las pacientes con deseo gestacional deben ser informadas de las potenciales complicaciones graves con una nueva gestación.…”

Repeat Cesarean Sections: Maternal and Neonatal Outcomes and Complications

“…Some have confirmed the increase in severe complications with the increase in the number of previous cesarean sections. (14,15,17) and some have not confirmed serious morbidities (18, 19). In general, there is no accurate data on the maximum number of cesarean sections that are not associated with serious consequences for subsequent cesarean sections in a woman.…”

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

“…As for the baby, it may have trouble breastfeeding and may be at greater risk for breathing problems [3,20,21]. Besides, evidences showed that having a CS increases the risk of complications in a later pregnancy and in other surgeries [22,23].…”