Higher order repeat caesarean sections: how safe are five or more?

Abstract

Objective To determine the maternal morbidity and mortality associated with multiple repeat caesarean sections. Design Retrospective study.Setting Security Forces Hospital serving Ministry of Interior and Security Forces personnel in Riyadh, Kingdom of Saudi Arabia. Population Three hundred and eight case records undergoing between fifth and ninth caesarean section (mean 7) were studied and compared with a control group of 306 patients undergoing third or fourth caesarean section during the period January 1994 -December 2002. Main outcome measure Operative and post-operative complications and difficulties.Results Five or more caesarean sections were associated with a longer operating time as well as an increased rate of severe adhesions. Blood transfusion rate was similar in the two groups but a drop of pre-operative to post-operative haemoglobin was significantly higher in the study group compared with the controls. There was no significant difference in the Apgar score of the baby, neonatal admission rate, incidence of caesarean hysterectomy, uterine scar rupture, placenta praevia, placenta accreta, bladder injury, incidence of postpartum pyrexia, wound infection and urinary tract infection between the two groups. There was no maternal death in the study group but one mother died in the control group. Conclusion The higher order (5 -9) repeat caesarean sections carry no specific additional risk for the mother or the baby when compared with the lower order (3 or 4) repeat caesarean sections.

Comparative study of abnormal placentation in patients with previous two caesarean section over two time periods

“…This is similar to birth weights by Sobande A and Rashid M et al where mean birth weight were 2.972 kg and 2.966 kg respectively. 2,6 Birth weights were lower compared to study by Macones GA and Cahill AG et al in which mean birth weight was 3.392kg and 3.046kg respectively. 7,8 Lower birth weight can be explained by the fact that the patients in our country are constitutionally small as compared to their western counterparts along with anaemia, preeclampsia, abnormal placentation and multitude of social problems.…”

“…As per Rashid M et al 25%, Nisenbalt V et al 11% and Robert M. Silver et al 22% required obstetrics hysterectomy. [2][3][4] Our study showed higher rates compared to all the above studies, although the rates are falling due to advent of conservative techniques in management of adherent placenta. As per study by AF Hundley, 90% of women were successfully managed with conservative treatment using methotrexate therapy.…”

“…In study by Rashid M et al 4 % required resuscitation and 20% NICU admission. 2 From this study we conclude that although the absolute number of women with previous two caesarean section has reduced due to better family planning services, the rate of abnormal placentation has increased. In this study due to lack of previous operative notes, or incomplete documentation in the previous operative notes we could not assess other concomitant factors responsible for abnormal placentation.…”

Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study

“…Our study found a significant increase in the rates of placenta praevia (16%), placenta accreta (14%), MOH (18%), blood transfusion (17%), hysterectomy (9%), visceral damage (5%) and critical care admission (13%) in women undergoing MRCS compared with women having caesarean sections after fewer previous procedures. Other studies of women undergoing their fifth or greater caesarean section describe lower rates of placenta praevia (between 2% and 4%), 9,12,14 placenta accreta (between 1% and 3.5%) 9,12 and hysterectomy (between 0.8% and 5%). 9,12,14 These differences may be accounted for by our study being the only prospective population, rather than a hospital-based cohort, and therefore encompassing deliveries of all complexities occurring in local and tertiary units.…”

“…Other studies of women undergoing their fifth or greater caesarean section describe lower rates of placenta praevia (between 2% and 4%), 9,12,14 placenta accreta (between 1% and 3.5%) 9,12 and hysterectomy (between 0.8% and 5%). 9,12,14 These differences may be accounted for by our study being the only prospective population, rather than a hospital-based cohort, and therefore encompassing deliveries of all complexities occurring in local and tertiary units. However, a limitation of this study is the relatively small cohort size, which may also account for discrepancies in comparisons with other studies.…”