Number Of Previous Cesarean Sections Research Articles

Multiple repeat caesarean section: is it safe?

Objective: We aimed to evaluate the obstetric outcome of patients without obstetric risks, who had two or more previous caesarean sections (C/S) prior to the current pregnancy, which was managed by caesarean section in our obstetric department. Methods: We studied the case notes of 602 women who had a repeat caesarean section in our unit between May 2002–June 2003. We then compared the two groups: (1) those who had two or more previous caesarean sections and (2) those who had only one previous caesarean section. Results: In the study group, while dense intraperitoneal adhesions were present in 3.6% of the patients, they were not found in control group. This difference was statistically significant ( P < 0.05). Uterine wound separation rate was 1.9% in the study group and none of the patients in control group had uterine wound separation, which was statistically significant also ( P < 0.05). There was no statistically significant association between Apgar scores and number of previous caesarean sections. Postoperative complication rates did not differ between the two groups ( P > 0.05). Conclusion: Patients without any obstetric risks, with two or more previous caesarean sections had significantly more dense adhesions and uterine wound separations in the current caesarean section compared to patients with one previous caesarean section. But, maternal and fetal mortality and morbidity in women who have two or more previous caesarean sections did not differ from the patients with one previous caesarean section.

Maternal morbidity with elective repeat cesarean section: The influence of the number of previous cesarean sections

Maternal morbidity with elective repeat cesarean section: The influence of the number of previous cesarean sections

Previous cesarean section and abortion as risk factors for developing placenta previa.

To determine the risk of subsequent occurrence of placenta previa in women with a history of previous cesarean sections and/or spontaneous and induced abortions. A retrospective analysis of all single gestation deliveries at National University Hospital of Singapore from 1993-1997 was done. Women with placenta previa were identified by clinical or ultrasonographic diagnosis. Of the 16,169 singleton deliveries, 164 women (1.0%) had placenta previa. Women with placenta previa had a significantly higher incidence of previous cesarean sections (p < 0.001). Among the 164 women with placenta previa, women with 1, 2, and 3 previous cesarean sections had 2.2 (95% CI 1.4, 3.4), 4.1 (95% CI 1.9, 8.8) and 22.4 (95% CI 6.4, 78.3) times increased risk of developing placenta previa respectively. Similarly, women with 2 or more previous abortions had a 2.1 (95% CI 1.2, 3.5) times increased risk of subsequently developing placenta previa. There is a strong association between previous cesarean section and risk of subsequent development of placenta previa. This risk increased with the number of previous cesarean sections. Increasing frequency of abortions was also found to predispose a woman to placenta previa.

Placental praevia and accreta: an analysis of two-years' experience

This retrospective review of the case records was designed to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. All women delivered with the diagnosis of placenta praevia at Princess Badeea Teaching Hospital from 1 January 1995 to 31 December 1996 were analysed. There were 18 651 deliveries in the study period. Sixty-five had placenta praevia, 21 of whom had a history of previous caesarean. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%) (P<0.0001). The risk increased as the number of previous caesarean sections increased. We also conclude that there is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections.

Placenta praevia and accreta: Analysis of a Two-Year Experience

Objective: Our purpose was to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. Method: A retrospective review of the case records of all women delivered with the diagnosis of placenta praevia during the 2-year period from January 1, 1995, to December 31, 1996, at the tertiary referral centre, Princess Badeea Teaching Hospital, in north Jordan. Results: There were 18,651 deliveries in the study period. 65 (0.35%) had placenta praevia, 21 (32.3%) of whom had a history of previous caesarean section. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%); p < 0.0001). This risk increased as the number of previous caesarean sections increased: 1.78% for one previous section; 2.4% for two, and 2.8% for three or more. The incidence of anterior placenta praevia and placenta accreta was significantly increased in those with previous caesarean scars. In the group without antecedent of caesarean section, accretism risk was 9%, with one section or more 40.8% (p < 0.005). Conclusion: There is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections. Patients with an antepartum diagnosis of placenta praevia who have had a previous caesarean section should be considered at high risk of developing placenta praevia and accreta.

Risk factors and morbidity in patients with placenta previa accreta compared to placenta previa non‐accreta

Placenta accreta is associated with high morbidity and most cases occur with placenta previa. This study was carried out in an attempt to define risk factors for placenta accreta in cases of placenta previa and to quantify the increased morbidity of placenta previa accreta in comparison to placenta previa alone. The records of all patients delivered by cesarean section (CS) for placenta previa and accreta during the seven-year period from 1990 to 1996, inclusive, were reviewed. Data regarding the demographic features, previous CS, the incidence of hysterectomy and postpartum morbidity were analyzed. Out of 23070 deliveries 110 (0.48%) had placenta previa, twelve (0.05%) of whom had placenta previa accreta. There was no significant difference in age and parity. Patients with a history of previous CS showed a significant increase in the incidence of placenta previa accreta (p=0.001). The percentage of accreta increased linearly from 4.1% in patients with no CS to 60% in patients who had had three or more CS. Postpartum hemorrhage and emergency hysterectomy were significantly higher among the previa accreta patients compared with the previa patients alone (p<0.001; p<0.001, respectively). In the presence of a previous history of CS, patients with antepartum diagnosis of placenta previa are considered to be at a greater risk for having placenta accreta. The risk increases with the increase in the number of previous CS. Patients with placenta previa accreta have a significantly higher incidence of PPH and are more likely to undergo emergency hysterectomy.

One or multiple previous cesarean sections are associated with similar increased frequency of placenta previa

Objective: The purpose of this study was to determine whether multiple previous cesarean sections would be associated with a higher frequency of placenta previa in subsequent deliveries than in women with only one previous cesarean section. Study design: Data of all pregnant women and deliveries were obtained from the computerized records of our department for the period 1985–1992. The study group included symptomatic placenta previa diagnosed by real time ultrasound or during labor. The data included maternal age, gravidity, parity and previous cesarean sections. Nulliparous women were excluded from the study. Results: There were 58 633 deliveries during the study period, including 284 patients with placenta previa (0.48%). Increasing maternal age was associated with a higher frequency of placenta previa. Similar results were found with increasing parity. A more significant trend was found with increasing number of previous abortions. Among placenta previa deliveries 21.1% of patients had previous cesarean section, and among normal deliveries only 10.9% had previous cesarean section ( P < 0.0001). The frequency of placenta previa in women with previous normal deliveries was 0.79 1000 ; in women with one previous cesarean section 15.39 1000 ; with two previous cesarean section 13.91 1000 ; with three previous cesarean sections 10.37 1000 . While the difference between none and one previous cesarean sections was highly significant ( P < 0.0001), the difference between one and more cesarean sections was not significant. Conclusion: Although the rate of placenta previa was significantly lower among deliveries without previous cesarean section in comparison with deliveries with one previous cesarean section, this difference was not enhanced with the increasing number of previous cesarean sections.

Placenta previa and previous cesarean section

Objective: To assess the relationship between previous cesarean section and subsequent development of placenta previa and placenta previa with accreta. Method: The records of all patients delivered with the diagnosis of placenta previa during the 10-year period from 1984 to 1993 were reviewed. Results: From a total of 50 485 deliveries, 421 (0.83%) had placenta previa, 43 (10.2%) of whom had a history of previous cesarean section. The incidence of placenta previa was significantly increased in those with a previous cesarean section (1.31%) compared with those with an unscarred uterus (0.75%) (R.R. 1.64). This risk increased as the number of previous cesarean sections increased (R.R. 1.53 for one previous section, 2.63 for two or more). The incidence of an anterior placenta previa and placenta accreta was significantly increased in those with previous cesarean scars. The incidence of placenta accreta was 1.18% among patients with placenta previa, 80% being in patients with previous cesarean section. The relative risk for placenta accreta in patients with placenta previa was 35 times higher in those with a previous cesarean section than in those with an unscarred uterus. Conclusion: The association of previous cesarean section with placenta previa and placenta previa accreta is confirmed. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk for developing placenta accreta.

Previous Caesarean Section and the Rising Incidence of Placenta Praevia and Placenta Accreta

SummaryOut of a total of 25 551 deliveries, the diagnosis of placenta praevia requiring a caesarean section was made in 124 patients (0.48 per cent). The risk of placenta praevia with an unscarred uterus was 0.42 per cent. The risk increased with the number of previous caesarean sections to 22.2 per cent in patients who had four or more sections.Patients who had placenta praevia and an unscarred uterus had a 3 per cent risk of having placenta accreta. With previous caesarean section and placenta praevia, the risk increased linearly with the number of previous sections to 50 per cent in patients who had had 4 or more caesarean sections.

Vaginal delivery following previous cesarean section in 1983

In 1983 the question whether or not to perform vaginal delivery following previous cesarean section is again presented to the obstetrical community. Data are presented on 778 patients managed during the decade January 1, 1973 to December 31, 1982. Four hundred seventy-six had scheduled repeat cesarean section on an elective basis. One hundred sixty-five experienced normal vaginal delivery. One hundred thirty-seven failed the attempt and were delivered by cesarean section. The group that delivered vaginally and scheduled elective cesarean section did well. However, in the failed attempt the problems were awesome regardless of indication or number of previous cesarean sections.