Obstet Gynecol Sci.  2014 May;57(3):187-192. 10.5468/ogs.2014.57.3.187.

Intra-operative complications increase with successive number of cesarean sections: Myth or fact?

• Zia S
• Rafique M

• KMID: 1704424
• DOI: http://doi.org/10.5468/ogs.2014.57.3.187

Abstract

OBJECTIVE
To determine whether complications related to surgery increase with increasing number of cesarean sections (CSs) in upper segment placenta. To compare the complications in urgent and elective high order (4-6) repeat CSs.
METHODS
A retrospective analysis of 519 women who underwent repeat CS was performed from January to December 2012. Women were divided into 3 groups: group 1 with previous 3 CS (n=325), group 2 with previous 4 CS (n=139), and group 3 with previous > or =5 CS (n=55).
RESULTS
Statistically significant differences (P < 0.001) were observed among 3 groups, regarding mean gravidity, type of CS, midline incision and bilateral tubal ligation performed. The risks of severe intra-peritoneal adhesions, thin out lower uterine segment and bladder injury were significantly increased (P < 0.001) with increasing number of CS deliveries. Only one cesarean hysterectomy was done in group 1 due to post partum hemorrhage. No significant differences were found in blood loss, duration of surgery, post operative hospital stay as well as birth weight and Apgar scores of newborns. The elective and emergency CS groups of high order repeat CS had no remarkable differences in operative, post operative complications and fetal outcome.
CONCLUSION
Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.

Keyword

Fetal outcome; Intra-operative complications; Multiple cesarean sections; Pregnancy outcome

MeSH Terms

Birth Weight
Cesarean Section*
Emergencies
Female
Gravidity
Hemorrhage
Humans
Hysterectomy
Infant, Newborn
Length of Stay
Placenta
Pregnancy
Pregnancy Outcome
Pregnant Women
Retrospective Studies
Sterilization, Tubal
Urinary Bladder

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