Effect of Multiple Repeat Cesarean Sections on Maternal Morbidity: Data from Southeast Turkey

Background: Cesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity.
Material and Methods: A total of 2460 patients who underwent delivery by CS at a center in southeast Turkey between January 2012 and January 2014 (24 months) were included in the study. The patients were divided into 5 groups according to the number of CSs, and the maternal and neonatal outcomes of the groups were retrospectively evaluated.
Results: A statistically significant difference was found between the groups in terms of maternal age, education level, time of hospitalization, operating time, the presence of dense adhesions, bowel and bladder injury, the presence of placenta previa, hysterectomy, blood transfusion requirements, and need for intensive care (p<0.05). Placenta previa (OR, 11.7; 95% CI, 2.6–53.2) and placenta accreta (OR, 12.2; 95% CI, 3.9–37.8) were found to be important risk factors in terms of the need for hysterectomy. No statistically significant difference was found between the groups for gestational age at birth, birth weight, fifth-minute APGAR score, preoperative and postoperative hemoglobin levels, uterine rupture, wound infection, wound dehiscence, placenta accreta, maternal death, and endometritis (p>0.05). A total of 4 or more CSs was identified as the critical level for most of the major complications.
Conclusions: An increasing number of CSs is accompanied by serious maternal complications. Four or more CSs are of especially critical importance. Decreasing the number of cesarean sections is required to decrease relevant complications. Vaginal birth after CS is an option that should be recommended to the patient.

Keywords: Birth Weight, Apgar Score, Adult, Blood Transfusion - statistics & numerical data, Cesarean Section, Repeat - statistics & numerical data, Educational Status, Endometritis - etiology, Gestational Age, Hemoglobins - analysis, Hysterectomy - statistics & numerical data, Infant, Newborn, Intestines - injuries, Intraoperative Complications - epidemiology, maternal health, Placenta Previa - epidemiology, Postoperative Complications - etiology, Pregnancy, Puerperal Disorders - etiology, Tissue Adhesions - epidemiology, Turkey - epidemiology, Urinary Bladder - injuries, Vaginal Birth after Cesarean, young adult