Multiple Repeated Cesarean Deliveries: Operative Complications in the Fourth and Fifth Surgeries in Urgent and Elective Cases

Abstract

Multiple repeated cesarean sections increase the risks for operative complications and poor perinatal outcomes. Patients must be informed about the related risks of multiple repeated cesarean sections and tubal ligation needs to be encouraged.

Obstetricians’ perspective towards cesarean section delivery based on professional level: experience from Egypt

“…The complications of cesarean section including maternal mortality, viscous injury, prolonged operative time, need for blood transfusion or hysterectomy and the post-operative complications increase with repeated cesarean section especially with high order CS [7]. These complications might not be so worrying in western communities because of small family size and rarity of performing high order CS.…”

Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans

“…Additionally, delivery at 37 or 38 weeks was not associated with decreased maternal morbidity . Onset of labor among women with multiple cesarean was reported to be associated with an increased risk of maternal complications, such as scar dehiscence, myometrial herniation, and organ injuries . Elective repeat cesarean scheduled at 39 weeks was found to be associated with an increased risk of maternal adverse outcomes as compared with planned delivery at 38 weeks .…”

Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries

“…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.).…”

“…One study with a total of 5007 women pointed out that vertical skin incision in these cases is not associated with improved maternal and fetal outcome [9]. Furthermore, the results of another study suggest that the risks of an urgent multiple cesarean section are in the range of elective multiple cesarean section [6,18]. There were, however, differences for myometrium herniation during this cesarean section, a need for drainage following surgery, and postoperative fever as well as hospitalization (days), which was held due to the urgency.…”