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Maternal morbidity associated with multiple repeat cesarean deliveries.

Robert M Silver1, Mark B Landon, Dwight J Rouse

  • 1Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. Bob.Silver@hsc.utah.edu

Obstetrics and Gynecology
|June 2, 2006
PubMed
Summary

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Maternal morbidity significantly increases with each repeat cesarean delivery. Healthcare providers should consider the number of pregnancies when counseling on repeat cesarean versus trial of labor.

Area of Science:

  • Obstetrics and Gynecology
  • Surgical Outcomes
  • Maternal Health

Background:

  • Repeat cesarean deliveries are a common surgical procedure.
  • Serious maternal morbidity associated with repeat cesarean deliveries is often underestimated.
  • Evaluating morbidity solely on abdominal deliveries overlooks the impact of multiple cesareans.

Purpose of the Study:

  • To quantify the increased maternal morbidity associated with a higher number of cesarean deliveries.
  • To provide data for informed patient counseling regarding repeat cesarean sections.

Main Methods:

  • Prospective observational cohort study.
  • Involved 30,132 women undergoing cesarean delivery without labor.
  • Data collected across 19 academic centers over a 4-year period (1999-2002).

Related Experiment Videos

Main Results:

  • Significant increases in risks of placenta accreta, cystotomy, bowel/ureteral injury, ileus, need for ventilation, ICU admission, hysterectomy, and major blood transfusion with more cesareans.
  • Placenta accreta risk rose from 0.24% (first) to 6.74% (sixth+).
  • Hysterectomy risk increased from 0.65% (first) to 8.99% (sixth+).
  • For women with placenta previa, accreta risk reached 67% by the fifth repeat cesarean.

Conclusions:

  • Maternal morbidity escalates progressively with the number of cesarean deliveries.
  • Counseling should incorporate the number of intended pregnancies when discussing elective repeat cesarean versus trial of labor.
  • The findings support careful consideration of elective primary cesarean delivery.