Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section

Arlıer, Sefa; Seyfettinoğlu, Sevtap; Yılmaz, Ertan; Nazık, Hakan; Adıgüzel, Cevdet; Eskimez, Eda; Hürriyetoğlu, Şerif; Yücel, Oğuz

doi:10.1007/s00404-016-4221-8

Cited by 32 publications

(32 citation statements)

References 35 publications

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“…20 Second, severe adhesions induced by previous surgery are often inevitable, and thus could increase operative difficulties. 21,22 The surgery duration in multiparas group was higher than that in primiparas group in both the non-matched and matched cohorts, suggesting increased operative difficulties in patients who underwent a previous cesarean delivery. Therefore, based on the above information, it can be speculated that multiparas might experience more postoperative pain than primiparas.…”

Section: Discussionmentioning

confidence: 97%

<p>Repeated Cesarean Delivery Predicted a Higher Risk of Inadequate Analgesia Than Primary Cesarean Delivery: A Retrospective Study with Propensity Score Match Analysis</p>

Yang¹,

Bao²,

Peng³

et al. 2020

JPR

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Purpose: This study aimed to compare the analgesic outcomes between primary and repeated cesarean delivery. Patients and Methods: We performed a retrospective analysis based on the medical records of a teaching hospital in China from January 2018 to March 2019. We collected data on demographic characteristics, perioperative complications, anesthesia, and surgical factors for cesarean delivery patients. We also recorded the postoperative analgesic strategy, pain intensity (assessed by the number rating scale) during the first 48 hrs after surgery, hospital cost, and hospital stay. Postoperative inadequate analgesia was defined by a score of ≥ 4 in the number rating scale. Analgesic outcomes after cesarean delivery between primiparas and multiparas were compared using propensity score matching analysis. Moreover, subgroup logistic analysis for different age groups (≥ 35 and < 35 years) was performed to investigate the effect of the maternal category on postoperative inadequate analgesia. Results: A total of 1543 patients were included in the analysis and 571 pairs (1142 patients) were matched in the primiparas and multiparaparas group according to their propensity score. In both the non-matched and matched cohort, the incidence of inadequate analgesia in the primiparas group was lower than that in the multiparas group (16.7% vs. 24.0%, P < 0.001 and 16.1% vs. 23.5%, P = 0.002; respectively). The multiparas group was identified as being at risk of inadequate analgesia after cesarean delivery in both age groups (age ≥ 35 years, odds ratio: 2.18, 95% confidence interval: 1.20-3.95; age < 35 years, odds ratio: 1.43, 95% confidence interval 1.08-1.89). Conclusion: Multiparas that undergo a repeat cesarean delivery had a significantly higher risk of inadequate postoperative pain treatment than primiparas. The maternal category should be considered when formulating the postoperative analgesia strategy after cesarean delivery.

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Section: Discussionmentioning

confidence: 97%

<p>Repeated Cesarean Delivery Predicted a Higher Risk of Inadequate Analgesia Than Primary Cesarean Delivery: A Retrospective Study with Propensity Score Match Analysis</p>

Yang¹,

Bao²,

Peng³

et al. 2020

JPR

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“…As expected from the usual clinical experience, the dates of Table 1 show an increased rate of uterine rupture with rising number of repeat cesarean section, again especially in the group of higher order cesarean section (more than three). Surprisingly in reality, most of the analyzed studies confirm Bladder injury 0.09% n = 6/6616 [5,8,10,11] 0.06% n = 10/17,378 [3,5,8,10,11] 0.23% n = 17/7201 [3,5,8,10,11] 0.81% n = 20/2461 [3,5,8,10,11] Bowel injury 0.13% n = 6/6616 [5,8,10,11] 0.09% n = 10/17,378 [3,5,8,10,11] 0.18% n = 17/7201 [3,5,8,10,11] 0.85% n = 20/2461 [3,5,8,10,11] Uterus rupture 0.43% n = 126/28,810 [8,12] 0.61% n = 52/8542 [3,8,12] 3.71% n = 29/782 [3,8] 4.34% n = 41/945 [3,…”

Section: Uterine Scar Rupturementioning

confidence: 99%

“…Like with the other maternal risks, a higher order repeat cesarean section (more than three) means a significant higher rate of placenta praevia, placenta accreta, and hysterectomy (Table 1) [3,8,10,11].…”

Section: Abnormal Placental Invasion and Hysterectomymentioning

confidence: 99%

“…There are several significant maternal complications such as visceral injury, uterine rupture, abnormal placentation, hysterectomy, bleeding and transfusions, severe adhesions, etc., most of which increase with an increasing number of repeated cesarean sections. There are also neonatal risks: babies born via multiple repeat cesarean section are more likely to experience breathing difficulties and to require admission to neonatal intensive care [4,5,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries

Zwergel¹,

Kaisenberg²

2020

Recent Advances in Cesarean Delivery

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The professionalization of women has shifted family planning to increased maternal ages. This has increased the use of assisted reproduction. Therefore, the tolerance toward suboptimal outcome of pregnancy decreases, and self-determined decision-making is on the rise. Once women have made the decision for elective cesarean section in their first pregnancy, subsequent pregnancies may result in multiple cesarean deliveries. This chapter analyzes the risks associated with higher multiple cesarean deliveries, such as bleeding and transfusion, adhesions, bowel and urinary tract injury, and uterus rupture. It also discussed the risks for vaginal birth following cesarean (VBAC) following multiple cesareans. Also there are neonatal risks involved, and women may require specific obstetric anesthesia. The chapter will analyze the risks for the offspring and the mother depending on the number of previous cesarean sections. This may enable detailed counseling of parents before a higher multiple repeat cesarean section is performed.

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“…Moving incision pain VAS at PO 48h 20 (12,27) 14 (10,20) Visceral pain VAS at PO 48h 0 (0, 8) 0 (0, 5)…”

Section: Resultsmentioning

confidence: 99%

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

Duan

Yang

Peng

et al. 2019

Preprint

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Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: From January to May 2017, a total of 168 patients (67 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (RR, 3.56 [1.05 to 12.04], P=0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. Trail Registration: ClinicalTrial.gov: NCT03009955, Date registered: December 30, 2016.

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Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section

Abstract: Emergency operations and adhesions increased complications.

Cited by 32 publications

References 35 publications

<p>Repeated Cesarean Delivery Predicted a Higher Risk of Inadequate Analgesia Than Primary Cesarean Delivery: A Retrospective Study with Propensity Score Match Analysis</p>

<p>Repeated Cesarean Delivery Predicted a Higher Risk of Inadequate Analgesia Than Primary Cesarean Delivery: A Retrospective Study with Propensity Score Match Analysis</p>

Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

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