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Am J Perinatol 2019; 36(04): 346-351
DOI: 10.1055/s-0038-1673653
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk of Maternal Morbidity with Increasing Number of Cesareans

Kristina E. Sondgeroth
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Leping Wan
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Roxane M. Rampersad
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Molly J. Stout
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
George A. Macones
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Alison G. Cahill
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Methodius G. Tuuli
2   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Funding This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD061619, Principal Investigator Cahill) and Robert Wood Johnson Foundation (66329, Principal Investigator Cahill). The contents of this publication are solely the responsibility of the authors.
Further Information

Publication History

10 April 2018

28 August 2018

Publication Date:
29 October 2018 (online)

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Abstract

Objective To estimate the risk of perioperative morbidity with increasing number of cesareans.

Study Design We conducted a retrospective cohort study from 2004 to 2010. Patients delivered by cesarean were included. Outcome measures were a composite organ injury (bowel or bladder), hysterectomy, hemorrhage requiring transfusion, severe morbidity, or surgical site complications. The Cochran–Armitage's test of trend was used to assess increasing incidence of each morbidity with number of prior cesareans. Multivariable logistic regression was used to estimate adjusted risks for each morbidity with increasing number of cesareans compared with primary cesarean.

Results Of the 15,872 women in the cohort, 5,144 had cesarean delivery: 3,113 primary, 1,310 one prior, 510 two prior, and 211 three or more prior cesareans. There was a significant increase in organ injury, hysterectomy, and surgical site complications with increasing number of cesareans. In multivariable analysis, the risk of organ injury and hysterectomy was increased compared with primary cesarean after two prior cesareans, and after three or more cesareans for hemorrhage requiring transfusion and surgical site complications.

Conclusion The risks of organ injury and hysterectomy are increased after two or more prior cesareans, and risks of hemorrhage and surgical site complications are increased after three or more cesareans.

Keywords

maternal morbidity - cesarean - complications - repeat cesarean

Note

This study was presented as a poster presentation at the 37th Annual Meeting of the Society for Maternal-Fetal Medicine, January 23–28, 2017, Las Vegas, NV.


Ethical Approval

This study was conducted with the approval of the Institutional Review Board: IRB Approval no. 201404055.


 

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