Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata

The present study aimed to investigate the perinatal morbidity associated with multiple repeat cesarean deliveries (CD) and, thus, to achieve a body of evidence for the current practice of discouraging pregnancy after undergoing three CDs.

This study prospectively reviewed a total of 500 women who consecutively underwent CD between January 1, 2009 and April 1, 2009. The patients were allocated into four groups based on the number of CDs they had undergone (Group 1: first CD, Group 2: second CD, Group 3: third CD, Group 4: fourth CD). Data related with their demographic and clinical characteristics were recorded as well as their perioperative characteristics and clinical characteristics of the neonates born to them. Cochran-Armitage test for trends and Spearman rank correlation analysis test was used to evaluate the trend of perioperative complications and neonatal outcome with the increasing number of CDs.

The mean age, gravidity and parity were significantly higher in groups 2-4 than those of the women who had their first CD (Group 1). The average operation time and mean delivery time as well as severe adhesions, bowel injury increased significantly with the number of CD. Neonatal characteristics were similar among groups except for a trend towards a decrease in the rate of meconium stained and a trend towards increase in the rate of neonatal sepsis with the increasing number of CD.

We have found positive correlation between the maternal morbidity and the number of CDs. The occurrence of adhesions emerges as the most significant indicator of maternal morbidity, eventually leading to the neighboring organ injury and prolonged operation time.