Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome

Area of Science:

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

Background:

• Multiple cesarean sections (CSs) are increasingly common.
• The risks associated with numerous repeat CSs require thorough investigation.

Purpose of the Study:

• To evaluate maternal and neonatal complications in women undergoing multiple repeat cesarean sections (≥4 CSs).
• To compare outcomes between women with ≥4 CSs and those with 2-3 CSs.

Main Methods:

• Retrospective case-control study.
• 144 women with ≥4 CSs compared to 288 women with 2-3 CSs.
• Analysis of maternal, operative, and neonatal complications.

Main Results:

• Women with ≥4 CSs experienced longer operating times, severe adhesions, and increased blood loss requiring transfusion.
• Significant increases in uterine rupture, placenta previa, preterm birth, and lower Apgar scores were observed in the high-repeat CS group.
• No significant differences in placenta accreta, major organ injury, cesarean hysterectomy, wound infections, or neonatal outcomes (NICU admissions, birth weights, perinatal mortality).
• A higher incidence of at least one major complication occurred in women with ≥4 CSs.

Conclusions:

• Multiple repeat cesarean sections elevate the risk of uterine rupture and intraoperative complications, classifying these patients as high-risk.
• No definitive upper limit for repeat CSs can be established.
• Informed consent regarding the risks of multiple CSs and recommendation for tubal ligation are crucial.