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Repeat C-Sections Raise Risk of Maternal Morbidity

Reuters Health Information 2006. © 2006 Reuters Ltd.
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NEW YORK (Reuters Health) May 31 - As the number of repeat c-sections increases, so does the risk of bowel injury, ICU admission, and other maternal complications, according to a report in the June issue of Obstetrics and Gynecology.

In light of this finding, "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," lead author Dr. Robert M. Silver, from the University of Utah School of Medicine in Salt Lake City, and colleagues note.

The findings are based on analysis of data for 30,132 women who underwent c-section without labor in 19 academic centers from 1999 to 2002. "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 investigators report.

The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, ileus, postoperative ventilatory use, ICU admission, and blood transfusion of at least 4 units were directly related to the number of cesarean deliveries. In addition, both the operative time and hospital stay rose as the number of c-sections increased.

The rate of placenta accreta ranged from 0.24% in first-time c-section patients to 6.74% in women with six or more c-sections. In women with previa, the rates were much higher, ranging from 3% in first-time c-section patients to 67% in women with at least five c-sections.

The hysterectomy rate was lowest in second-time c-section patients and highest in those with at least six c-sections, ranging from 0.42% to 8.99%.

"Women planning large families should consider the risks of repeat cesarean deliveries when contemplating elective cesarean delivery or attempted vaginal birth after cesarean delivery," the authors conclude.

Obstet Gynecol 2006.