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

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Outcomes

Background:

• Multiple repeat caesarean sections are increasingly common.
• Understanding the risks associated with higher-order repeat procedures is crucial for patient counseling and management.
• Previous studies have yielded conflicting results regarding the safety of 5+ caesarean sections.

Purpose of the Study:

• To evaluate maternal morbidity and mortality in women undergoing five or more repeat caesarean sections.
• To compare outcomes with women undergoing third or fourth repeat caesarean sections.

Main Methods:

• Retrospective study conducted at Security Forces Hospital, Riyadh, Saudi Arabia.
• Compared 308 women undergoing 5th-9th caesarean section (mean 7) with 306 women undergoing 3rd-4th caesarean section.
• Assessed operative and post-operative complications, including adhesions, blood loss, and infection rates.

Main Results:

• Women undergoing 5+ caesarean sections experienced longer operating times and increased severe adhesions.
• Drop in hemoglobin was significantly higher in the 5+ caesarean section group.
• No significant differences were observed in rates of caesarean hysterectomy, uterine rupture, placenta accreta, bladder injury, infections, or neonatal outcomes. Maternal mortality was low in both groups.

Conclusions:

• Higher-order (5-9) repeat caesarean sections do not appear to carry specific additional risks compared to lower-order (3-4) repeat sections.
• Careful surgical technique and patient selection remain important for all repeat caesarean deliveries.