From Safety to Risk: Maternal Morbidity in Women Undergoing Multiple Repeat Cesarean Deliveries

Öz

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.

Anahtar Kelimeler

• Cesarean delivery
• maternal
• multiple repeat
• neonatal
• outcomes

Kaynakça

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