Higher order multiple repeat cesarean sections: maternal and fetal outcome

Multiple repeat cesarean delivery is common in many parts of Saudi Arabia. We conducted a retrospective analysis of patient records to determine the major and minor complications as well as the neonatal outcome associated with multiple repeat cesarean sections.

We analyzed relationships between the number of cesarean sections and various demographic and clinical variables in 150 patients undergoing 4 to 8 cesarean sections (mean 6.0) compared with a control group of 140 patients undergoing 2 to 3 cesarean sections (mean 2.5) during the period from 1996 to 2000 at the Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia.

Both the gestation age of the mother and birth weight of the baby were lower in the study group compared with the control group (mean gestation age 36 weeks in the study group compared with 37 weeks in the control group (P=0.001), and mean birth weight 2.9 kg for infants in the study group compared with 3.1 kg in the control group (P=0.01). The total duration of the operation was longer in the study group (63 minutes on average) compared with the control (45 minutes on average) (P=0.001). There were 80 cases of severe adhesion encountered during surgery in the study group compared with 40 cases in the control group (P=0.001). There was no difference in the Apgar score of the baby and the neonatal admission rate in the two groups. The incidence of cesarean hysterectomy, uterine scar dehiscence, placenta placenta previa, placenta accreta and bladder injury was similar in two groups. The incidence of post partum pyrexia, wound infection, urinary tract infection, and blood transfusion was also comparable in the two groups.

No specific additional risk is associated with higher order (four to eight) repeat cesarean sections that is not normally encountered with lower order (two to three) repeat cesarean sections.