Four or More Cesarean Sections, is it Still Safe?

Abstract

OBJECTIVE:We aimed to compare the maternal and neonatal complications in women who had undergone fourth or more cesarean section with to women who had undergone second or third cesarean section.STUDY DESIGN: 162 women who had four or more cesarean section (study group) and 228 women who had undergone second or third cesarean section (control group) were reviewed retrospectively. Demographic features, obstetric, intraoperative, postpartum and neonatal complications were determined in both groups. RESULTS:The preoperative hematocrit values were lower in study group (35.6±3.6) than the control group (36.6±4.3), (p<0.001). Patients with four or more cesarean sections had an increased rate (24.7%) of intra-abdominal dense adhesions compared with the controls (14.9%), (p<0.001). Blood transfusion rate was higher in the study group (8.6% to 3.5%, p=0.043). Except these; frequencies of obstetric, intraoperative, postpartum and neonatal complications were similar between groups. CONCLUSION:We found that multiple CSs (four or more) do not increase the risk of maternal or neonatal complications except the rate of maternal anemia, dense adhesions and need for blood transfusion according to the results of our study. Fourth or more cesarean section appears to be still a safe procedure.

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

“…They did not detect any differences, with the exception of an increase in intraabdominal adhesions. In our study, the prevalence of bladder and bowel injury was found to be low, which is consistent with the extent literature 2,18. We believe that careful abdominal entry plays an important role in reducing damage to these organs.…”

“…The most commonly discussed issues in studies pertaining to the number of CSs are the causes of maternal morbidity. However, more consistent results regarding neonatal outcomes have been reported 2,6…”

“…Gasim et al17 found that blood loss and the need for blood transfusion increased in patients with four or more CSs compared to patients with two to three CS. Yucel et al2 found that multiple CSs (four or more) do not increase the risk of maternal or neonatal complications, with the exceptions of rates of maternal anemia, dense adhesions, and the need for blood transfusion. In contrast to those studies, the need for blood transfusion was not significantly different among the two groups in our study.…”

“…Accordingly, repeat cesarean section may increase the risk of morbidity and mortality. A repeat cesarean delivery carries significantly greater risk in terms of abnormal placentation, morbidly adherent placenta, uterine rupture, injury to adjacent organs, excessive blood loss, hysterectomy, and even maternal death 2. Many researchers also contend that those risks increase as the number of repeat CSs increases.…”

Subcutaneous tissue stiffness of cesarean incision scar by elastography as a predictor of intra‐abdominal adhesions

“…Adhesion formations are increased with each repeated CS, increasing intraoperative and postoperative morbidity. [2][3][4] Predicting adhesion formations before surgery is important to reduce the intraoperative complications and related morbidities. Therefore, many studies have been conducted to predict adhesions before a repeated CS.…”