Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience

Abstract

Objective:To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections.Methods:Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 (18.5%) had previously had four or more cesarean sections (multiple repeat cesarean section group) and 1074 (81.5%) had previously had two or three cesarean sections (control group). Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests.Results:The adhesion rate (p < 0.001), number of blood transfusion (p = 0.044), operation time (p = 0.012), length of hospital stay (p < 0.001) and tubal ligation surgery (p < 0.001) were significantly higher in multiple repeat cesarean section group compared to control group.Conclusion:Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section.

Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries

“…The results of the trials show ( Table 1) that the quantity of any blood transfusion and also the rate of ICU admission are higher in the first cesarean section on the one side and in the higher order repeat cesarean section (≥4) on the other side than the number of transfusion in the second and third cesarean sections [3,5,10,11,13,14]. The increased number of blood transfusions and lengthened intensive care hospitalization following the first cesarean section may be explained by the fact that in this cohort, emergency deliveries and more unexpected situations are included, compared with the cohort of the elective second or third cesarean sections.…”

“…Some of the analyzed studies pointed out that there is a significant higher rate of blood loss or any blood transfusion especially in the group of more than three repeat cesarean sections [3,7,13,15,18]. This may be due to a higher rate of adhesions, visceral injury, and possibly abnormal placentation (see also 3.4.).…”

“…As explained above, placenta previa and placenta accreta were found to be one of the most important risk factors in terms of the need for hysterectomy [19]. Therefore, the rate of hysterectomy after multiple repeat cesarean section rises parallel to the rate of placenta previa and accreta [3,8,10,11,13].…”

“…[30] 0.72% n = 372/50,685 [30] 0.19% n = 42/50,685 [30] 1.21% n = 358/50,685 [30] Second CS -0.61% n = 52/8542 [3,8,12] 0.43% n = 75/17,378 [3,8,10,11] 1.58% n = 273/17,280 [3,5,10,11] VBAC 2 71.70% n = 4064/5666 [30] 1.36% n = 74/5421 [30] 0.56% n = 14/2512 [30] 2.01% n = 39/5666 [30] Third CS -3.71% n = 29/782 [3,8] 0.91% n = 65/7106 [3,8,10,11] 2.23% n = 157/7050 [3,5,10,11] VBAC > 2 79.7 7 % n = 71/89 [31] 0.00% n = 0/89 [31] n.k. 2.20% n = 2/89 [31] ≥4 CS -4.34% n = 41/945 [3,4,8,13] 2.49% n = 66/2652 [3,8,10,11,13] 5.35% n = 142/2652 [3,5,10,11,13,14] VBAC1/VBAC2 = vaginal birth after one/two cesarean sections; CS = cesarean section…”

Complications of Cesarean Operation

“…Modifications to surgical techniques have not yet been adequately evaluated in the long term such as the decision not to close the peritoneum, and more conclusive evidence is needed regarding the formation or not of adhesions [64][65][66][67][68][69][70][71][72][73].…”