The effects of repeated caesarean sections on maternal and fetal outcomes
Objectives : To determine (i) the effects of repeated caesarean sections on maternal and fetal outcomes (ii) whether these outcomes are affected by the timings of caesarean section (elective/emergency). Materials and Methods: This is a retrospective observational study conducted at Al Qassimi Hospital, Sharjah UAE from 1st Jan 2007 to 31st Dec 2008. 224 women who underwent caesarean section (CS) for two or more times were studied with respect to timing of current caesarean section, adhesions, condition of bladder and lower uterine segment, dehiscence of previous scar and any visceral injuries. Total blood loss and postoperative complications were also evaluated. Fetal parameters included gestational age at birth, APGAR scores and breathing difficulties if any. Results: Incidence of dense adhesions increased with increasing number of caesarean sections (22% for prev 2CS, 33% for prev 3 CS, 39% for prev 4 or more CS). Omental adhesions also followed similar pattern. The lower segment was thinned out in 38% of total patients. Scar dehiscence was seen in 50% of previous 4 caesarean section operated in emergency, in comparison to 4% and 6%% in previous 2 and 3 caesarean section. Other complications like bleeding, blood transfusion and postoperative complications were not statistically different in both the groups (elective and emergency). There was no case of caesarean hysterectomy and maternal death. The fetal outcome was similar in all the groups. Conclusions: No definitive upper limit of multiple repeat caesarean sections can be fixed for an individual woman based just on the number of previous Caesarean sections.