How safe is high-order repeat cesarean delivery? An 8-year single-center experience in Lebanon

To quantify the impact of the number of prior cesarean deliveries (CD) on operative complications and preterm birth. Then to investigate the presence of a threshold, beyond which complications tend to be disproportionately dangerous.

This was a retrospective cohort observational study, where data corresponding to all CD done at our service, during an 8-year period, were collected and analyzed. In total, 1840 CD were performed. Patients were divided into five categories that corresponded to the number of CD. Primary outcome was the composite adverse maternal outcome, while preterm birth and individual complications were secondary outcomes.

The composite adverse maternal outcome, preterm birth, as well as all individual complications related to CD, except for placental abruption, showed a significant rise in frequency that paralleled the increase in the number of CD. Furthermore, this increase tended to be continuous as the number of CD increased, with an evident surge after the fourth.

In our population, increasing number of prior CD was a risk factor for a parallel increase in the rate of composite adverse maternal outcome, preterm birth and almost all intraoperative complications attributable to CD. Decreasing exposure to such surgeries by limiting family size to four offspring should be considered seriously in patient counseling.