Maternal Morbidity with Repeated Cesarean Deliveries

Area of Science:

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

Background:

• Repeated cesarean deliveries (CDs) are common, raising concerns about potential increases in maternal morbidity.
• Understanding the association between the number of prior CDs and adverse outcomes is crucial for patient counseling and clinical decision-making.

Purpose of the Study:

• To estimate the association between the number of repeated cesarean deliveries (CDs) and adverse maternal outcomes.
• To investigate subgroup differences, particularly in women with and without placenta previa.

Main Methods:

• Retrospective cohort study of 3,582 women undergoing CD between 2005 and 2020.
• Analysis of electronic records for baseline characteristics and pregnancy/surgical outcomes based on the number of prior CDs.
• Subgroup analyses for women with and without placenta previa, using chi-square for trend and ANOVA.

Main Results:

• Adverse maternal outcomes, including placenta accreta and uterine dehiscence, increased with a higher number of CDs, though absolute rates remained low.
• In women without placenta previa, the likelihood of adverse outcomes did not significantly differ across CD groups.
• Uterine dehiscence incidence significantly increased with successive CDs, from 0.2% for the first to over 10% for sixth or higher CDs.

Conclusions:

• Maternal morbidity generally increases with repeated cesarean deliveries, but absolute risks are low even for high-order CDs.
• For women without placenta previa, additional CDs do not appear to increase maternal morbidity.
• Women with placenta previa experience higher risks with increasing CDs, highlighting the need for careful consideration in delivery timing.