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Tang D, Laporte A, Gao X, Coyte PC. The Effect of the Two-Child Policy on Cesarean Section in China: Identification using Difference-in-Differences Techniques. Midwifery 2022; 107:103260. [DOI: 10.1016/j.midw.2022.103260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 11/17/2022]
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Narava S, Pokhriyal SC, Singh SB, Barpanda S, Bricker L. Outcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates: A retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247:143-148. [PMID: 32113061 DOI: 10.1016/j.ejogrb.2020.01.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 11/19/2022]
Abstract
TITLE Outcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates. OBJECTIVE To describe the operative outcomes, clinical findings, maternal morbidity and neonatal outcome associated with increasing numbers of cesarean deliveries. DESIGN Retrospective study. SETTING Corniche Hospital, Abu Dhabi, United Arab Emirates. POPULATION The study cohort was 1008 women giving birth by cesarean section who had previously undergone one or more cesarean sections, who had a singleton pregnancy, and who were not in labor. METHODS A retrospective study was undertaken over the one-year period from January 2016 to December 2016. Women were divided into five groups according to number of previous cesarean sections. The first group comprised of women who had one previous cesarean section, the second group women who had two previous cesarean sections, the third group consequently three previous cesarean sections and the fourth group four previous cesarean sections, whereas in the fifth group women had previously five or more previous cesarean sections. The maternal and neonatal outcomes of the groups were retrospectively evaluated. RESULTS The risks of placenta previa, placenta accreta, uterine dehiscence or rupture, postpartum hemorrhage, blood transfusion, bladder injury, lengths of operative time and hospital stay, and number of admissions to the high dependency unit increased with increasing numbers of previous cesarean sections. Women with five or more previous cesarean sections had a 10-fold increased risk of placenta previa (odds ratio [OR], 9.8; 95 % confidence interval [CI], 3.3-28.6), a 27 - fold increased risk of placenta accreta (OR, 26.5; 95 % CI, 4.2-166.3), and an 11-fold increased risk of uterine dehiscence or rupture (OR, 11.3; 95 % CI, 1.8-70.8). DISCUSSION The results of our study indicate that serious maternal morbidity increases with increasing numbers of previous cesarean sections. Women planning large families should consider the risks of repeat cesarean sections when contemplating elective primary cesarean delivery or attempted vaginal birth after one previous cesarean section.
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Affiliation(s)
- Sumalatha Narava
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates.
| | | | - Sushma Balbir Singh
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates.
| | - Samikshyamani Barpanda
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates.
| | - Leanne Bricker
- Fetal Medicine Department, Corniche Hospital, Abu Dhabi, United Arab Emirates.
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Biler A, Ekin A, Ozcan A, Inan AH, Vural T, Toz E. Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience. Pak J Med Sci 2017; 33:1074-1079. [PMID: 29142541 PMCID: PMC5673710 DOI: 10.12669/pjms.335.12899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections. Methods: Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 (18.5%) had previously had four or more cesarean sections (multiple repeat cesarean section group) and 1074 (81.5%) had previously had two or three cesarean sections (control group). Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests. Results: The adhesion rate (p < 0.001), number of blood transfusion (p = 0.044), operation time (p = 0.012), length of hospital stay (p < 0.001) and tubal ligation surgery (p < 0.001) were significantly higher in multiple repeat cesarean section group compared to control group. Conclusion: Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section.
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Affiliation(s)
- Alper Biler
- Alper Biler, Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Atalay Ekin, Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Aykut Ozcan
- Aykut Ozcan, Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Abdurrahman Hamdi Inan
- Abdurrahman Hamdi Inan, Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tayfun Vural
- Tayfun Vural, Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Emrah Toz
- Emrah Toz, Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
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Yaman Tunc S, Agacayak E, Sak S, Basaranoglu S, Goruk NY, Turgut A, Tay H, Elci E, Gul T. Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity? J Matern Fetal Neonatal Med 2016; 30:739-744. [PMID: 27125601 DOI: 10.1080/14767058.2016.1183638] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity. METHODS MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files. RESULTS The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture. CONCLUSIONS According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.
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Affiliation(s)
- Senem Yaman Tunc
- a Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Elif Agacayak
- a Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Sibel Sak
- b Department of Obstetrics and Gynecology , School of Medicine, Harran University , Sanliurfa , Turkey
| | - Serdar Basaranoglu
- c Department of Obstetrics and Gynecology , School of Medicine, Fatih University , Istanbul , Turkey
| | - Neval Yaman Goruk
- d Department of Obstetrics and Gynecology , Memorial Hospital , Diyarbakir , Turkey , and
| | - Abdulkadir Turgut
- a Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Hayrettin Tay
- e Department of Obstetrics and Gynecology , Private Batman Dunya Hospital , Batman , Turkey
| | - Evindar Elci
- a Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Talip Gul
- a Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
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Alnoman A, El-Khatib Z, M S Almrstani A, Walker M, El-Chaar D. Case series of multiple repeat caesarean sections: operative, maternal, and neonatal outcome. J Matern Fetal Neonatal Med 2015; 29:1972-6. [DOI: 10.3109/14767058.2015.1071347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Intra-operative complications increase with successive number of cesarean sections: Myth or fact? Obstet Gynecol Sci 2014; 57:187-92. [PMID: 24883289 PMCID: PMC4038684 DOI: 10.5468/ogs.2014.57.3.187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/18/2013] [Accepted: 10/31/2013] [Indexed: 12/26/2022] Open
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 ≥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.
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Rossouw JN, Hall D, Harvey J. Time between skin incision and delivery during cesarean. Int J Gynaecol Obstet 2013; 121:82-5. [DOI: 10.1016/j.ijgo.2012.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 11/04/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022]
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Gedikbasi A, Akyol A, Bingol B, Cakmak D, Sargin A, Uncu R, Ceylan Y. Multiple Repeated Cesarean Deliveries: Operative Complications in the Fourth and Fifth Surgeries in Urgent and Elective Cases. Taiwan J Obstet Gynecol 2010; 49:425-31. [DOI: 10.1016/s1028-4559(10)60093-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2009] [Indexed: 10/18/2022] Open
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Wilson S, Fecho K, Marshall J, Spielman F. Factors influencing cesarean delivery operative times: a prospective observational cohort study. Int J Obstet Anesth 2010; 19:417-21. [DOI: 10.1016/j.ijoa.2010.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 04/09/2010] [Accepted: 06/19/2010] [Indexed: 11/27/2022]
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Ma LK, Liu N, Bian XM, Teng LR, Qi H, Gong XM, Liu JT, Yang JQ. Pregnancy outcomes of repeat cesarean section in Peking Union Medical College Hospital. ACTA ACUST UNITED AC 2009; 24:147-50. [PMID: 19848314 DOI: 10.1016/s1001-9294(09)60079-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. METHODS A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007. RESULTS The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all P<0.01). The incidence of complication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P<0.05). Dense adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS group. Neonatal morbidity was similar among three groups (P>0.05). CONCLUSIONS Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.
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Affiliation(s)
- Liang-Kun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107:1226-32. [PMID: 16738145 DOI: 10.1097/01.aog.0000219750.79480.84] [Citation(s) in RCA: 995] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although repeat cesarean deliveries 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 the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries. METHODS Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002). RESULTS There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively. CONCLUSION Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Nisenblat V, Barak S, Griness OB, Degani S, Ohel G, Gonen R. Maternal Complications Associated With Multiple Cesarean Deliveries. Obstet Gynecol 2006; 108:21-6. [PMID: 16816051 DOI: 10.1097/01.aog.0000222380.11069.11] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The claim that a planned repeat cesarean delivery is safer than a trial of labor after cesarean may not be applicable to women who desire larger families. The aim of this study was to assess maternal complications after multiple cesarean deliveries. METHODS The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group). RESULTS Excessive blood loss (7.9% versus 3.3%; P < .005), difficult delivery of the neonate (5.1% versus 0.2%; P < .001), and dense adhesions (46.1% versus 25.6%; P < .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004). CONCLUSION Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Victoria Nisenblat
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
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Moodliar S, Moodley J, Esterhuizen TM. Complications associated with caesarean delivery in a setting with high HIV prevalence rates. Eur J Obstet Gynecol Reprod Biol 2006; 131:138-45. [PMID: 16806653 DOI: 10.1016/j.ejogrb.2006.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 03/08/2006] [Accepted: 05/04/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was designed to determine the prevalence of complications associated with abdominal delivery in a setting of high caesarean section (C/S) and HIV rates. METHOD A detailed review of the records of 737 C/S performed over a three-month period was conducted in a tertiary teaching hospital in Durban, South Africa. RESULTS The overall complication rate was 14.2%. Major complications included endometritis, wound sepsis, post-partum haemorrhage and bladder injury. HIV infection may have a negative impact on morbidity rates. Disimpacting the fetal head vaginally had a significant association with endometritis (p=0.021). The use of a corrugated drain did not prevent wound sepsis (p<0.001). CONCLUSION Complications associated with C/S are common is a setting of high C/S rates and HIV infection.
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Affiliation(s)
- S Moodliar
- Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Sobande A, Eskandar M. Multiple Repeat Caesarean Sections: Complications and Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:193-197. [PMID: 16650356 DOI: 10.1016/s1701-2163(16)32105-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the complications and outcomes of Caesarean section (CS) in women who have had three or more previous lower segment Caesarean sections with those in women with one previous CS. METHODS We performed a retrospective study of 371 patients undergoing repeat CS. Of these, 115 (31%) had previously had three or more Caesarean sections (group 1) and 256 (69%) had previously had one CS (group 2). All 371 patients had the repeat CS performed at Abha Maternity Hospital, Saudi Arabia between June 2002 and May 2004. Demographic data, complications, and outcomes were compared using the Student t and chi-square tests. RESULTS There were statistically significant differences between the two groups with respect to mean maternal age, parity, gestation at delivery, and experience of the surgeon (P < 0.05). CS was performed as an emergency in 38 (32.9%) and 186 (72.6%) of patients in groups 1 and 2 respectively (P < 0.05). The consultant was involved in the decision to perform CS in 215 (84.6%) of patients with one previous CS. There were significant differences between the two groups in the type of skin incision, the presence of dense adhesions during surgery, and bladder injury (P < 0.05). There were no statistically significant differences in birth weight, stillbirth rate, low Apgar score, blood loss during surgery, duration of surgery, or the duration of postoperative hospital stay. CONCLUSION The prevalence of dense intra-abdominal adhesions and of bladder injury during CS was higher in women with a history of three or more previous CS than in women with one previous CS. Placenta previa and Caesarean hysterectomy occurred with equal frequency in each group, and wound dehiscence and uterine rupture were rare.
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Affiliation(s)
- Adekunle Sobande
- Department of Obstetrics and Gynaecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mamdoh Eskandar
- Department of Obstetrics and Gynaecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. Multiple cesarean section morbidity. Int J Gynaecol Obstet 2005; 87:227-32. [PMID: 15548394 DOI: 10.1016/j.ijgo.2004.08.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 08/09/2004] [Accepted: 08/13/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify maternal risk associated with multiple cesarean sections (CSs) and determine whether the third CS defines a threshold for increased morbidity. METHODS From January 1997 to January 2002, the clinical records of 3191 women who were delivered by CS at our referral maternity center were examined for selected indicators of maternal morbidity. The women were assigned to groups based on number of CSs and the frequency of each indicator was determined. A composite score for each indicator among women grouped by number of consecutive CSs was then derived to compare risk between groups and against the third CS. RESULTS By all indicators studied, morbidity increased with successive CSs before and through the third CS. However, compared with the third, the risk of major morbidity was significantly increased with the fifth, and much worse at the sixth CS for placenta previa (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.9-7.4), placenta accreta (OR=6.1, 95% CI=2.0-18.4) and hysterectomy (OR=5.9, 95% CI=1.5-24.4). But the third and fourth CSs had the same risk of major morbidity for placenta previa (OR=1.4, 95% CI=0.8-2.2), placenta accreta (OR=1.0, 95% CI=0.3-2.9) and hysterectomy (OR=0.3, 95% CI=0.0-2.7). CONCLUSIONS The third CS does not define a threshold for increased risk to the mother. Instead, overall morbidity rises continually with each successive CS. However, specifically for major morbidity from the triad of placenta previa, placenta accreta and hysterectomy during CS, the fourth CS carries the same risk as the third.
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Affiliation(s)
- F W Makoha
- Department of Obstetrics and Gynecology, Maternity and Children's Hospital, Jeddah, Saudi Arabia.
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Thurman AR, Zoller JS, Swift SE. Non-pregnant patients' preference for delivery route. Int Urogynecol J 2004; 15:308-12. [PMID: 15580415 DOI: 10.1007/s00192-004-1164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 03/15/2004] [Indexed: 11/25/2022]
Abstract
The objective of the study was to survey non-pregnant women regarding their preference for obstetric delivery route and to assess their awareness of the maternal and fetal risks of obstetric delivery. We wished to determine the percentage of non-pregnant women who would choose elective cesarean section and to correlate demographic factors. We compared women who elected cesarean delivery versus vaginal delivery. All patients presenting for routine gynecologic care were asked to complete an anonymous survey. Demographic variables analyzed were patient age, race, employment, insurance type and household income. Secondary data regarding knowledge of the risks and benefits of cesarean and vaginal delivery were assessed with a Likert Scale. Of patients surveyed, 13.3% preferred cesarean section. The only significant demographic factor was was race, with 21.7% of non-whites and 7.8% of whites choosing cesarean section. Most patients agreed that elective cesarean sections should be performed and reimbursed by insurance. The majority of women answered neutral regarding the maternal and neonatal risks of obstetrical delivery. The unique feature of this observational study is the sole participation of non-pregnant patients. The percentage of women who would elect cesarean section has significant public health implications. The only difference noted between demographic groups is that non-white women had a stronger preference for cesarean. Without counseling, most women are unsure of the risks of delivery route on maternal and neonatal health.
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Affiliation(s)
- Andrea R Thurman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Clinical Sciences Building Suite 634, 96 Jonathan Lucas Street, PO Box 250619, Charleston, SC 29425, USA.
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