The MFMU cesaraean section registry: Maternal morbidity associated with multiple repeat cesarean delivery

Abstract

36 37 THE MFMU CESARAEAN SECTION REGISTRY: MATERNAL MORBIDITY ASSOCIATED WITH MULTIPLE REPEAT CESAREAN DELIVERY ROBERT M. SILVER, MFMU Network, NICHD, Bethesda, Maryland OBJECTIVE: There has been a substantial increase in the rate of cesarean delivery (CD) over the past decade, including primary elective cases. In part, this has been justified by the relative safety of CD in modern obstetrics. Although multiple repeat CD often are associated with serious morbidity they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate whether morbidity is higher with increasing numbers of CD. STUDY DESIGN: Prospective observational cohort of 30,132 women with CD without labor in 19 academic centers over 4 years (1999–2002). RESULTS: The risk of accreta, accreta with previa, and hysterectomy increased with increasing numbers of CD (Table; all P ! .001), as did the risk of blood transfusion of 4 or more units (P ! .001). In the 143 women with accreta, the risk of cystotomy, but not other co-morbidity, increased with increasing number of CD (P ! .001). CONCLUSION: Serious maternal morbidity increases with increasing numbers of CD. Thus, the number of intended pregnancies should be factored into consideration of elective cesarean or VBAC attempts. This large series confirms the high risk of accreta in women with previa and 2 or more prior CD. However, the risk of accreta in women with previa and 1 prior CD is less than previously reported. () accretas in women with previas; Hyst – hysterectomy).