Abstract
References
- Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296:503-12.
- Gasim T, Al Jama FE, Rahman MS, Rahman J. Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome. J Reprod Med. 2013;58:312-8.
- Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15:e1002494.
- Betran AP, Torloni MR, Zhang JJ, et al. WHO working group on Caesarean section. WHO statement on caesarean section rates. BJOG. 2016;123:667-70.
- Smith V, Hannon K, Begley C. Clinician’s attitudes towards caesarean section: a cross-sectional survey in two tertiary level maternity units in Ireland. Women and Birth. 2022;35:423-8.
- Hacettepe University Institute of Population Studies (HUIPS). 2003 Turkey Demographic and Health Survey. https://fs.hacettepe.edu.tr/hips/dosyalar/Ara%C5%9Ft%C4%B1rmalar%20-%20raporlar/2003%20tnsa/ENG/TDHS_2003_main_report.pdf access date 13.06.2025.
- Hacettepe University Institute of Population Studies (HUIPS). 2008 Turkey Demographic and Health Survey. https://dhsprogram.com/pubs/pdf/FR351/FR351.pdf access date 13.06.2025.
- Hacettepe University Institute of Population Studies (HUIPS). 2018 Turkey Demographic and Health Survey. https://www.dhsprogram.com/pubs/pdf/FR372/FR372.pdf access date 13.06.2025.
- Ye J, Betran AP, Guerrero Vela M, et al. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41:237-44.
- Reddy UM, Abuhamad AZ, Levine D, Saade GR.; Fetal Imaging Workshop Invited Participants. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med. 2014;33:745-57.
- Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2015;47:271-5.
- Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146:20-4.
- Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205:262.e1-8.
- Makoha FW, Felimban HM, Fathuddien MA, et al. Multiple caesarean section morbidity. Int J Gynaecol Obstet. 2004;87:227-32.
- Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217:27-36.
- Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.
- Tulandi T, Agdi M, Zarei A, et al. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201:56.e1-56.e6.
- Uygur D, Gun O, Kelekci S, et al. Multiple repeat caesarean section: is it safe?. Eur J Obstet Gynecol Reprod Biol. 2005;119:171-5.
- Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more?. BJOG. 2004;111:1090-4.
- Kaplanoglu M. Vaginal birth after cesarean section. Arch Med Rev J. 2014;23:624-36.
- Satitniramai S, Manonai J. Urologic injuries during gynecologic surgery, a 10‐year review. J Obstet Gynaecol Res. 2017;43:557-63.
- Qublan HS, Tahat Y. Multiple cesarean section. The impact on maternal and fetal outcome. Saudi Med J. 2006;27:210-4.
- Macones GA, Peipert J, Nelson DB, et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol. 2005;193:1656-62.
- Cahill AG, Waterman BM, Stamilio DM, et al. Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2008;199:32.e1-5.
- Oben A, Ausbeck EB, Gazi MN, et al. Association between number of prior cesareans and early preterm delivery in women with abnormal placentation. Am J Perinatol. 2012;38:326-31.
Abstract
Aim: The global rise in cesarean delivery (CD) rates, especially in low- and middle-income countries, has increased the prevalence of multiple repeat cesarean deliveries (MRCDs), raising concerns about associated maternal and neonatal morbidity. The objective of this study was to assess clinical outcomes related to MRCDs by comparing women with four or more prior CDs to those with fewer.
Material and Method: This study was retrospectively conducted involving 15,811 women with singleton pregnancies who underwent CD and had a history of at least one prior CD between January 2018 and December 2022. Participants were categorized into two groups: Group 1 (≤3 prior CDs) and Group 2 (≥4 prior CDs). Maternal demographics, intraoperative and postoperative outcomes, as well as neonatal outcomes, were analyzed and evaluated across the groups.
Results: Women in Group 2 had significantly higher rates of placenta previa (7.4% vs. 0.23%), placenta accreta (1.9% vs. 0.04%), cesarean hysterectomy (1.5% vs. 0.007%), intra-abdominal adhesion (7.3% vs. 1.21%), bladder injury (1.06% vs. 0.095%), and blood transfusion (8.7% vs. 2.6%) than those in Group 1 (all p<0.001). Neonatal outcomes were also adversely affected in Group 2, with lower gestational age at delivery (37.6 vs. 38.4 weeks) and increased NICU admission rate (10.2% vs. 7.6%; p<0.001).
Conclusion: MRCDs are significantly associated with increased maternal and neonatal morbidity, particularly in women with four or more previous CDs. These findings emphasize the need for comprehensive prenatal counseling, surgical preparedness, and efforts to reduce primary CD rates, while promoting trial of labor after CD when clinically appropriate.
Ethical Statement
Approved by University of Health Sciences Etlik Zübeyde Hanım Health Care Training and Research Hospital (Date, 20.05.2021, Reference Number: 07/10).
Thanks
The author would like to thank all the staff in our surgical and laboratory departments for their expert assistance in collecting the data.
References
- Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296:503-12.
- Gasim T, Al Jama FE, Rahman MS, Rahman J. Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome. J Reprod Med. 2013;58:312-8.
- Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15:e1002494.
- Betran AP, Torloni MR, Zhang JJ, et al. WHO working group on Caesarean section. WHO statement on caesarean section rates. BJOG. 2016;123:667-70.
- Smith V, Hannon K, Begley C. Clinician’s attitudes towards caesarean section: a cross-sectional survey in two tertiary level maternity units in Ireland. Women and Birth. 2022;35:423-8.
- Hacettepe University Institute of Population Studies (HUIPS). 2003 Turkey Demographic and Health Survey. https://fs.hacettepe.edu.tr/hips/dosyalar/Ara%C5%9Ft%C4%B1rmalar%20-%20raporlar/2003%20tnsa/ENG/TDHS_2003_main_report.pdf access date 13.06.2025.
- Hacettepe University Institute of Population Studies (HUIPS). 2008 Turkey Demographic and Health Survey. https://dhsprogram.com/pubs/pdf/FR351/FR351.pdf access date 13.06.2025.
- Hacettepe University Institute of Population Studies (HUIPS). 2018 Turkey Demographic and Health Survey. https://www.dhsprogram.com/pubs/pdf/FR372/FR372.pdf access date 13.06.2025.
- Ye J, Betran AP, Guerrero Vela M, et al. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41:237-44.
- Reddy UM, Abuhamad AZ, Levine D, Saade GR.; Fetal Imaging Workshop Invited Participants. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med. 2014;33:745-57.
- Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2015;47:271-5.
- Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146:20-4.
- Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205:262.e1-8.
- Makoha FW, Felimban HM, Fathuddien MA, et al. Multiple caesarean section morbidity. Int J Gynaecol Obstet. 2004;87:227-32.
- Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217:27-36.
- Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.
- Tulandi T, Agdi M, Zarei A, et al. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201:56.e1-56.e6.
- Uygur D, Gun O, Kelekci S, et al. Multiple repeat caesarean section: is it safe?. Eur J Obstet Gynecol Reprod Biol. 2005;119:171-5.
- Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more?. BJOG. 2004;111:1090-4.
- Kaplanoglu M. Vaginal birth after cesarean section. Arch Med Rev J. 2014;23:624-36.
- Satitniramai S, Manonai J. Urologic injuries during gynecologic surgery, a 10‐year review. J Obstet Gynaecol Res. 2017;43:557-63.
- Qublan HS, Tahat Y. Multiple cesarean section. The impact on maternal and fetal outcome. Saudi Med J. 2006;27:210-4.
- Macones GA, Peipert J, Nelson DB, et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol. 2005;193:1656-62.
- Cahill AG, Waterman BM, Stamilio DM, et al. Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2008;199:32.e1-5.
- Oben A, Ausbeck EB, Gazi MN, et al. Association between number of prior cesareans and early preterm delivery in women with abnormal placentation. Am J Perinatol. 2012;38:326-31.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | |
| Submission Date | May 12, 2025 |
| Acceptance Date | June 3, 2025 |
| Published in Issue | Year 2025 Volume: 7 Issue: 3 |
Chief Editors
Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye
Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
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