Maternal complications associated with multiple cesarean sections
DOI:
https://doi.org/10.52556/2587-3873.2022.2(93).07Keywords:
cesarean section, repeated cesarean section, multiple cesarean section, maternal complications, maternal morbidityAbstract
The incidence of primary and repeat cesarean sections (CS) is increasing worldwide. Globally, the incidence of CS has increased steadily from 6.7% in 1990 to 19.1% in 2014. The frequency of CS varies greatly across countries, and rates >50% for primary CS and >88 % for repeated CS. Consequently, there is a significant increase in higher-order cesarean sections with the association of severe complications. According to the statistical data of the Public Medical-Sanitary Institution Municipal Clinical Hospital „Gheorghe Paladi”, the number of total births decreased from 8330 in 2010 to 6685 in 2020. However, CS rates are increasing: from 14.3% in 2010 to 19.4% in 2020 for primary CSs and from 25.3% to 39.9%, respectively, for repeated CSs. The risk of rare but potentially serious maternal complications, such as visceral injury, hemorrhage, abnormal placentation, hysterectomy, or severe adhesions, increases significantly with the number of repeated CSs. About 9% of women undergoing multiple CSs experience major complications and about 1% require hysterectomy, most commonly as a result of abnormal placentation. There is no absolutely clear threshold for a safe number of CSs, but 4 or more cesarean deliveries represent a critical level for substantially increasing the frequency of major complications. Further clinical trials are needed to evaluate not only the effects of surgical techniques and intraoperative management in women with multiple CSs, but also to investigate perioperative and long-term morbidity.
References
1. Suhasini V. Intra-operative difficulties in repeat cesarean sections - a study of 200 cases. Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. 122 p.
2. Rottenstreich M., Sela H., Shen O. et al. Prolonged operative time of repeat cesarean is a risk marker for post-operative maternal complications. BMC Pregnancy Childbirth. 2018; 18(1): 477. https://doi.org/10.1186/s12884-018-2111-8
3. Seidman D., Paz I., Nadu A. et al. Are multiple cesarean sections safe? Eur J Obstet Gynecol Reprod Biol. 1994; 57(1): 7-12. https://doi.org/10.1016/0028-2243(94)90102-3
4. Blotnienė P., Žitkutė V., Volochovič J. et al. Multiple repeat cesarean sections - incidence and consequences: a review of 3 years in a tertiary hospital experience. J Med Sciences. 2019; 7(12): 1-8.
5. Yaman Tunc S., Agacayak E, Sak S. et al. Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity? J Matern Fetal Neonatal Med. 2017; 30(6): 739-744. https://doi.org/10.1080/14767058.2016.1183638
6. Kaplanoglu M., Bulbul M., Kaplanoglu D. et al. Effect of multiple repeat cesarean sections on maternal morbidity: data from southeast Turkey. Med Sci Monit. 2015; 21: 1447-1453. https://doi.org/10.12659/MSM.893333
7. Silver R.M., Landon M.B., Rouse D.J. et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107(6): 1226-1232. https://doi.org/10.1097/01.AOG.0000219750.79480.84
8. Nisenblat V., Barak S., Griness O. et al. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 2006; 108(1): 21-26. https://doi.org/10.1097/01.AOG.0000222380.11069.11
9. Zwergel C., Kaisenberg C. Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries. In: Recent Advances in Cesarean Delivery (ed. Georg Schmolzer). London: IntechOpen, 2020. https://www.intechopen.com/books/recent-advances-in-cesarean-delivery. https://doi.org/10.5772/intechopen.86334
10. Uygur D., Tapisiz O., Mungan T. Multiple repeat cesarean sections: maternal and neonatal outcomes. Int J Gynaecol Obstet. 2005; 89(3): 284-285. https://doi.org/10.1016/j.ijgo.2005.03.003
11. Makohaa F., Felimbana H., Fathuddiena M. et al. Multiple cesarean section morbidity. Int J Gynec Obstet. 2004; 87: 227-232. https://doi.org/10.1016/j.ijgo.2004.08.016
12. Kandil I.M., Farhan A.M., Shaker M.M. The Impact of Repeated Cesarean Sections on Perioperative Maternal Morbidity. Egypt J Hosp Med. 2019; 77(4): 5307-5312. https://doi.org/10.21608/ejhm.2019.55618
13. Osman S., Farid G., Kamal R. et al. Perinatal Morbidity & Mortality following repeat Cesarean section due to five or more previous Cesarean Section done in Tertiary centre in KSA. Clin J Obstet Gynecol. 2018; 1: 045-051. https://doi.org/10.29328/journal.cjog.1001007
14. Uyanikoglu H., Karahan M., Turp A. et al. Are multiple repeated cesarean sections really as safe? J Matern Fetal Neonatal Med. 2017; 30(4): 482-485. https://doi.org/10.1080/14767058.2016.1175426
15. Uygur D, Gun O, Kelekci S. et al. Multiple repeat caesarean section: is it safe? J Obstet Gynecol Reprod Biol. 2005; 119(2): 171-175. https://doi.org/10.1016/j.ejogrb.2004.07.022
16. Ghani A., Ila I., Ferdouse J. et al. Repeat Caesarean Sections: Complications and Outcomes. J Shaheed Suhrawardy Med Coll 2018; 10(2): 74-79. https://doi.org/10.3329/jssmc.v10i2.41161
17. Somani S., Sudhir S., Somani S. A study of intra-operative maternal morbidity after repeating caesarean section. Int J Reprod Contracept Obstet Gynecol. 2018; 7(1): 291-296. https://doi.org/10.18203/2320-1770.ijrcog20175864
18. Barbieri R.L. Repeat cesarean again and again and again. OBG Manag. 2005; 17(9): 8-9.
19. Dempsey A., Diamond K., Bonney E. et al. Caesarean section: techniques and complications. Obstet Gynaecol Reprod Med. 2017; 27(2): 37-43. https://doi.org/10.1016/j.ogrm.2017.01.003
20. Narava S., Pokhriyal S., Singh S. et al. 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. https://doi.org/10.1016/j.ejogrb.2020.01.035
21. Gedikbasi A., Akyol A., Bingol B. et al. Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases. Taiwan J Obstet Gynecol. 2010; 49(4): 425-431. https://doi.org/10.1016/S1028-4559(10)60093-9
22. Choudhary G.A., Patell M.K., Sulieman H.A. The Effects of Repeated Caesarean Sections on Maternal and Fetal Outcomes. Saudi J Med Med Sci. 2015; 3(1): 44-49. https://doi.org/10.4103/1658-631X.149676
23. Motomura K., Ganchimeg T., Nagata C. et al. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Sci Rep. 2017; 7: 44093. https://doi.org/10.1038/srep44093
24. Marshall N., Fu R., Guise J. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011; 205(3): 262.e1-8. https://doi.org/10.1016/j.ajog.2011.06.035
25. Qublan H., Tahat Y. Multiple cesarean section. The impact on maternal and fetal outcome. Saudi Med J. 2006; 27(2): 210-214. https://doi.org/10.15537/1658-3175.3313
26. Clark E.A., Silver R.M. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol. 2011; 205(6 Suppl): S2-10. https://doi.org/10.1016/j.ajog.2011.09.028
27. Palatnik A., Grobman W. The association of skinincision type at cesarean with maternal and neonatal morbidity for women with multiple prior cesarean deliveries. Eur J Obstet Gynecol Reprod Biol. 2015; 191: 121-124. https://doi.org/10.1016/j.ejogrb.2015.06.009
28. Shellhaas C., Gilbert S., Landon M. et al. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol. 2009; 114(2 Pt 1): 224-229. https://doi.org/10.1097/AOG.0b013e3181ad9442
29. Rotem R., Sela H., Hirsch A. et al. The use of a strict protocol in the trial of labor following two previous cesarean deliveries: Maternal and neonatal results. Eur J Obstet Gynecol Reprod Biol. 2020; 252: 387-392. https://doi.org/10.1016/j.ejogrb.2020.07.016
30. Sahooa H., Jeermisonb R. Repeated Caesarean Section delivery in India. Child Youth Serv Rev. 2020; 116(2020): 105258. https://doi.org/10.1016/j.childyouth.2020.105258
31. Dahlke J., Mendez-Figueroa H., Rouse D. et al. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol. 2013; 209(4):294-306. https://doi.org/10.1016/j.ajog.2013.02.043
32. Roberge S., Demers S., Berghella V. et al. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014; 211(5): 453-460. https://doi.org/10.1016/j.ajog.2014.06.014
33. Lyell D.J. Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol. 2011; 205(6 Suppl): S11-18. https://doi.org/10.1016/j.ajog.2011.09.029
34. Rossi A., D'Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. Am J Obstet Gynecol. 2008; 199(3): 224-231. https://doi.org/10.1016/j.ajog.2008.04.025
35. Mynbaev O., Babenko T., Ahmadi F. et al. Uterine Morbidity: Cesarean Section Scar Complications. In: Hysteroscopy (eds. Andrea TinelliLuis, Alonso Pacheco, Sergio Haimovich). Springer International Publishing AG, 2018, p. 421-468. https://doi.org/10.1007/978-3-319-57559-9_41
36. Biler A., Ekin A., Ozcan A. et al. Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience. Pak J Med Sci. 2017; 33(5):1074-1079. https://doi.org/10.12669/pjms.335.12899
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
