The maternal and fetal outcome of repeat previous one caesarean section


  • Uma Jain Department of Obstetrics and Gynacology, GMC Associated with DHS, Shivpuri, Madhya Pradesh, India
  • Deepali Jain GMC, Shivpuri, Madhya Pradesh, India
  • Shaily Sengar Department of Obstetrics and Gynaecology, GMC, Shivpuri, Madhya Pradesh, India
  • Preeti Gupta Gupta Hospital, Morar, Madhya Pradesh, India



Caesarean section, Maternal morbidity, Neonatal morbidity, VBAC


Background: The rates of adverse maternal and neonatal outcomes have increased significantly in the last decade. Patients with repeated caesarean deliveries also have a greater risk of placenta previa, placenta accrete, uterine rupture, bowel and bladder injury, and unplanned hysterectomy.

Methods: This retrospective study was performed between 01 April 2017 to 31 March 2021, at a private hospital to know about the surgical difficulties and maternal and neonatal complications encountered in cases of repeated LSCS. The outcome of 1028 women admitted with a history of previous LSCS was studied.

Results: The 613 patients were given a trial of labour. 40.07% of patients delivered normally. The most common indication for repeat LSCS was CPD in 20.94% and fetal distress 20.12%. The most common complication observed was adhesion in 37.65%. Scar dehiscence in 8.92 %, scar rupture in 0.64%, uterine atony in 4.8%, placenta previa in 3.57%, placenta accrete in 0.64%, injury to the bladder was seen in 0.97%, caesarean hysterectomy was done in only 2 cases and gaped wound was found in 1.13% of cases. 19.15% of neonates were admitted to NICU. Apgar score <7 at 5 minutes in 14.77%. premature neonates were 8.44% RDS was found in 7.62%, birth asphyxia was found in 2.92% cases and neonatal sepsis was found in 1.13%.

Conclusions: The dramatic increase in caesarean section rates over the past three decades has been associated with a corresponding increase in maternal morbidity but there a continuous decrease in neonatal morbidity and mortality rates because of advances in neonatal medicine.

Author Biographies

Uma Jain, Department of Obstetrics and Gynacology, GMC Associated with DHS, Shivpuri, Madhya Pradesh, India

Obstetric & Gynecology

Designated Professor, GMC Shivpuri.

Deepali Jain, GMC, Shivpuri, Madhya Pradesh, India

Senior Resident, Department of  Obstetrics & Gynaecology, GMC Shivpuri  M.P. India.

Preeti Gupta, Gupta Hospital, Morar, Madhya Pradesh, India

Department of Obstetrics and Gynaecology, Gupta Maternity hospital and infertility centre, Morar, Madhya Pradesh,


Betran AP, Ye J, Moller AB, Zhang J, Gulmexogly AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016;11(2):ee0148343.

Queenan JT, Spong CY, Lockwood CJ. The textbook of Management of high-risk pregnancy an evidence-based approach., Fifth edition, Michael w. warner Chapter 45, Caesarean delivery. Vaginal birth after caesarean delivery. 2015;389-96.

Munro Kerr’s Operative Obstetrics 12th Edition Chapter 13. Caesarean Section, Vaginal Birth After Caesarean Section. 2014;14;132-51.

Bottoms SF, Rosen MG, Sokol RJ. The increase in the caesarean birth. N Engl J Med. 1980;302:559-63.

Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breast G. Postpartum maternal mortality and caesarean delivery. Obstetr Gynecol. 2006;108(3-1):541-8.

Loston RM, Liu S, Joseph KS. Maternal mortality and severe morbidity associated with low-risk planned caesarean delivery versus planned vaginal delivery at term. Canadian Med Association J. 2007;176:4:455-60.

Gregory KD, Jackson S, Korst L, Fridman M. Caesarean versus vaginal delivery: whose risks? Whose benefits? Am j perinatol. 2012;29(1):7-18.

Gurol-Urganci l, Cromwell DA, Edozien LC. Risk of placenta previa in second birth after first birth caesarean section: a population-based study and meta-analysis. BMC Pregnancy childbirth. 2011;11(1):95.

Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal Morbidity for Vaginal and caesarean deliveries, according to previous caesarean history: New Data from the Birth Certificate. 2013.

National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital statistics system. 2015;64(4:)1-13.

Marshall NE, Fu R, Guise JM. Impact of multiple caesarean deliveries on maternal morbidity: a systematic review. Am J Obstetr Gynecol. 2011;205(3):262.e1-262.8.

Liu S, Heaman M, Joseph KS. Risk of maternal postpartum readmission associated with mode of delivery. Obstetr gynecol. 2005;105(4):836-42.

Flamm BL. Vaginal birth after caesarean section: controversies old and new. Clin Obstet Gynecol. 1985;28:735-44.

Goldman G, Pineault R, Potvin L, Vlais R, Bilodeau H. Factors influencing the practice of vaginal birth after caesarean section. Am Public Health. 1993;82:1104-8.

American College of Obstetricians and Gynecologists. Vaginal birth after previous caesarean delivery: clinical management guidelines for obstetrician-gynaecologists. ACOG Practice Bulletin 5. Washington DC. 1999.

Richa R, Mohanty S, Priyadarshini S. Uterine Scar Condition and Complications Associated with Repeat Caesarean Section: A study in a Tertiary Care Hospital. Int J Contemporary Med Res. 2019;6(12):2454-7379.

Nilanchali S, Reva T, MalaYM. Maternal and fetal outcomes in patients with previous caesarean section undergoing a trial of vaginal birth at a tertiary care centre in north India. J pregnancy child health. 2014;1:1.

George A, Arasi KV, Mathai S. Is vaginal birth after caesarean delivery a safe option in India. Int J Gyneacol Obstet. 2004;85:42-3.

Sen S, Malik S, Salhan S. Ultrasonographic evolution of lower uterine segment thickness in patients of previous caesarean section. Int J Gynecol Obstet. 2004;87:215-9.

Huang WH, Nakashima DK, Rumney PJ, Keegan KA, Chan K. Interdelivery interval and the success of vaginal birth after caesarean delivery. Obstet Gynecol. 2002;99:41-4.

Zelop CM, Shipp TD, Cohen R, Lieberman E. Effect of previous vaginal delivery on the risk of uterine rupture during a subsequent trial of labor Am J Obstet Gynecol. 2000;183:1184-6.

Lydon Rochelle MT, Gardella C, Cardenas V, Easterling TR. Repeat Caesarean Delivery: What indications are recorded in the medical chart. Birth. 2006;33:4-11.

Peaceman AM, Gersnoviez R, Landon MB, Spong CY, Leveno KJ et al. The MFMU Caesarean registry; Impact of fetal size on the trial of labor success for patients with the previous caesarean for dystocia. Am J Obstet Gynecol. 2006;195:1127-31.

Exechi OC, Exeobi PM, GabOkafor CV, Edet A, Nwoloro CA, Akinlade A. Maternal and Fetal effect of Misgav Ladach Caesarean Section in Nigerian Women: A Randomized Control Study. Ann Med Health Sci Res. 2013;3(4):577-82.

Lyell DJ. Adhesions and perioperative complications of repeat caesarean delivery. Am J Obstet Gynecol, 2011;205:11-18.

Tulandi T, Agdi M, Zarai A. Adhesion development and morbidity after repeat caesarean delivery. Am J Obstet Gynecol. 2009;201:et-612.

Kaplanoglu M, Bulbul M, Kaplanoglu D, Bakacak SM. Effect of multiple repeat caesarean section on maternal morbidity; Data from southeast Turkey, medical science monitor. Int Med j experimental clin res. 2015;21:1447-53.

Bhowmik J, Kyal A, Das I, Berwal V, Kanti Das P, Mukhopadhyay P. Pregnancy with previous caesarean section; An overview of adverse fetomaternal sequelae. Int J Repord Contracept Obstet Gynecol. 2018;7(5):1817-21.

Bailit JL, Landon MB, Thom E, Rouse DJ, Spong CY. The MFMU caesarean registry; Impact of time of day on caesarean complications: Am J Obstet Gynecol. 2016;195:1132-7.

Nazaneen S, Kumari A. Fetomaternal Outcomes of Pregnancy with Multiple Repeat Caesarean Sections in a Tertiary Hospital in North-East India. IOSR-JDMS. 2017;16:77-82.

Anagha A, Jinturkar D, Dipti. Study of the obstetric and fetal outcome of post caesarean section pregnancy at the tertiary care centre. Int J Recent Trends Tech. 2014;10(3):530-7.

Durnwald CP, Rouse DJ, Levano KJ. The maternal-fetal medicine units caesarean registry; Impact of time of day on caesarean complications. Am J Obstet Gynecol. 2006;195;1132-7.

Goel SS, Tiwari M, Hariharan C, Shrivastava DS. Outcome of post caesarean pregnancy and comparison of maternal and foetal outcome following vaginal birth versus repeat caesarean section in the hospital. Int J Reprod Contracept Obstet Gynecol. 2013;2(1):16-22.

Silver RM, Landon MB, Rouse DJ. Maternal morbidity associated with multiple repeat caesarean deliveries. Obstet Gynecol. 2006;107:1226.

Chowdhury SB, Newaz R, Begum A, Dewan Z. Indications and complications of caesarean section: a study of 1083 cases. Bangladesh J Obstet Gynecol. 1994;9:1-7.

Asaduzzaman K. A study on factors and outcome of cesarean section among the patients admitted in a tertiary care hospital, (Dissertation), Dhaka, Bangladesh College of Physicians and Surgeons. 1996.

ACOG Practice bulletin. Vaginal birth after previous caesarean delivery; Clinical management guidelines for obstetricians gynecological; American college of obstetricians and gynecology. Int J Gynecol Obstetric. 1998;66:197-204.

Ismail S, Umbeli T, Kunna A, Elmahgoub A. Maternal and neonatal complications associated with caesarean section in the second stage of labour at Omdurman maternity hospital during 2012-2013. Merit Res Med Medical Sci. 2014;2(10): 225-8.






Original Research Articles