The Impact of Repeated Cesarean Sections on Perioperative Maternal Morbidity

Abstract

Background: Rates of cesarean delivery vary internationally, but generally, it has shown a worldwide increase. Repeated cesarean deliveries was found to be associated with increased maternal morbidity, including placenta previa, placenta accreta, hysterectomy, adhesions, bladder injury, postoperative hemoglobin deficit and need for blood transfusion. Objective: In our study, we evaluated the outcome of emergency cesarean deliveries conducted at Bani Suef General Hospital and the impact of repeated cesarean deliveries on that outcome. Patients and methods: We recruited 300 patients admitted at the Casualty Department. The patients were divided equally into 3 groups (100 patients in each group) as follows: group 1: Patients with previous one cesarean delivery, group 2: Patients with previous two cesarean delivery and group 3: Patients with previous three or more cesarean deliveries. Results: The operative duration was statistically significantly longer in patients with previous three or more cesarean deliveries (group 3) than patients with previous one cesarean delivery (group 1) or previous two cesarean delivery (group 2) [74.4, 44.4, 56.4 min respectively, p < 0.001]. The estimated blood loss was found to be higher in group three than one and two attributed to higher incidence of placenta previa and placenta accrete in group three. The incidence of adhesions (omental and bladder) was significantly higher in group three, but the incidence of bowel adhesion was the same in group three and two (which was statistically not significant). Conclusion: The rate of complications was higher in group three (bladder and bowel injuries, scar dehiscence, placenta previa, placenta accreta, hysterectomy and post-operative ICU admission).