Repeated caesarean sections raise the risk of bowel injury, intensive care unit admission and other maternal complications. Researchers from the University of Utah School of Medicine in Salt Lake City found that the number of intended pregnancies should be considered during counselling regarding elective repeat caesarean operation versus a trial of labour and when debating the merits of elective primary caesarean delivery. The researchers analysed 30,132 women who underwent c-section without labour in 19 academic centres from 1999 to 2002. A total of 6,201 women had their first c-section, 15,808 had a second, 6,324 a third, 1,452 a fourth, 258 a fifth, and 89 women had five or more caesarean deliveries. The risk of complications, including urinary or bowel injury, the need for a ventilator after delivery, ICU admission, blood transfusion of four or more units, and placenta problems were directly related to the number of previous caesarean deliveries. In addition, the length of surgery and hospital stay rose as the number of c-sections increased. The rate of placenta accreta (when the placenta implants too far into the uterus) ranged from 0.24 percent in first-time c-section patients to nearly 7 percent in women who had six or more c-sections. In women with placenta praevia (when the placenta implants too close to the cervix) the rates were much higher, ranging from 3 percent in first-time c-section patients to 67 percent in women who had five or more c-sections. The hysterectomy rate was lowest in second-time c-section patients and highest in those who had at least six c-sections, ranging from 0.42 percent to 9 percent, respectively. The findings suggest that women planning large families should consider the risks of repeated caesarean deliveries when contemplating elective caesarean delivery or attempted vaginal birth after caesarean delivery.
Obstetrics and Gynecology,
June 2006