Maternal and neonatal morbidity associated with higher-order of four or more repeat cesarean sections: a retrospective cohort analysis in Dubai
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253502Keywords:
Uterine rupture, Retrospective cohort study, Repeat cesarean section, Dubai hospital, Placenta accreta spectrum, Maternal morbidity, Neonatal morbidity, NICU admissions, Peripartum hysterectomyAbstract
Background: Cesarean delivery rates have surged globally over the past few decades, with an increasing trend of repeat cesarean sections (CS), raising significant maternal and neonatal health concerns. The risks associated with higher-order (four or more) repeat cesarean deliveries are underexplored, especially concerning outcomes like maternal hemorrhage, uterine rupture, placenta accreta spectrum (PAS), and neonatal morbidity. This study aimed to analyze maternal and neonatal morbidity in women undergoing higher-order repeat cesarean sections, comparing these with outcomes in lower-order (three or fewer) CS deliveries, to provide insights for risk mitigation and informed decision-making.
Methods: A retrospective cohort study was conducted on patients who underwent repeat cesarean deliveries from January 2018 to December 2023. Data were gathered from electronic health records, focusing on key outcomes including maternal complications (e.g., blood transfusions, adhesions, ICU admissions) and neonatal complications (e.g., NICU admissions, respiratory distress). Statistical analysis was used to assess correlations and compare morbidity
outcomes between groups.
Results: Findings indicated significantly higher morbidity in the higher-order CS group. Elevated risks of hemorrhage, peripartum hysterectomy, organ injuries, and neonatal NICU admissions were observed. These findings highlight the need for enhanced clinical strategies and informed counselling for women with multiple prior cesarean sections.
Conclusions: This study underscored the increased maternal and neonatal risks associated with four or more repeat cesarean sections. These results support the importance of careful prenatal monitoring, informed patient counselling, and targeted interventions to mitigate risks for high-order repeat cesarean deliveries.
Metrics
References
Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: a call to action. Health Sci Rep. 2023;6(5). DOI: https://doi.org/10.1002/hsr2.1274
Jurdi R. Cesarean section rates in the Arab region: a cross-national study. Health Policy Plann. 2004;19(2):101-10. DOI: https://doi.org/10.1093/heapol/czh012
Abdulrahman M, Abdullah SS, Alaani AFK, AlAbdool NH, Sherif FEY, Ahmed ZS, et al. Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary care hospitals in the United Arab Emirates. Rev Brasil Gineco Obstet. 2019;41(03):147-54. DOI: https://doi.org/10.1055/s-0038-1676524
Zhou C, Zhang L, Bao Y, Li L, Zhang T, Zhang X, et al. Effect of blood transfusion during cesarean section on postpartum hemorrhage in a tertiary hospital over a 4-year period. Medicine. 2021;100(3):e23885.
Hassanabad AF, Zarzycki AN, Jeon K, Deniset JF, Fedak PWM. Post-operative adhesions: a comprehensive review of mechanisms. Biomedicines. 2021;9(8):867.
Tarney CM. Bladder injury during cesarean delivery. Curr Women’s Health Rev. 2014;9(2):70-6. DOI: https://doi.org/10.2174/157340480902140102151729
Morlando M, Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies. Int J Women’s Health. 2020;12:1033-45. DOI: https://doi.org/10.2147/IJWH.S224191
Liu X, Wang Y, Wu Y, Zeng J, Yuan X, Tong C, et al. What we know about placenta accreta spectrum (PAS). Eur J Obstet Gynecol Reprod Biol. 2021;259:81-9. DOI: https://doi.org/10.1016/j.ejogrb.2021.02.001
Yeganegi M, Bahrami R, Azizi S, Marzbanrad Z, Hajizadeh N, Mirjalili SR, et al. Cesarean section and respiratory system disorders in newborns. Eur J Obstet Gynecol Reprod Biol X. 2024;23:100336.
Yadav S, Lee B. Neonatal respiratory distress syndrome. In: StatPearls. StatPearls Bookshelf; 2023.
Pegu B, Thiagaraju C, Nayak D, Subbaiah M. Placenta accreta spectrum- a catastrophic situation in obstetrics. Obstet Gynecol Sci. 2021;64(3):239-47. DOI: https://doi.org/10.5468/ogs.20345
Verticchio J, Tuuli M, Odibo A, Macones G, Cahill A, Conner S. Maternal obesity and risk of post cesarean wound complications. Am J Perinatol. 2013;31(04):299-304. DOI: https://doi.org/10.1055/s-0033-1348402
Teefey CP, Reforma L, Koelper NC, Sammel MD, Srinivas SK, Levine LD, et al. Risk factors associated with cesarean delivery after induction of labor in women with class III obesity. Obstet Gynecol. 2020;135(3):542-9. DOI: https://doi.org/10.1097/AOG.0000000000003703
Dietl A, Cupisti S, Beckmann M, Schwab M, Zollner U. Pregnancy and obstetrical outcomes in women over 40 years of age. Geburt Frauen. 2015;75(08):827-32. DOI: https://doi.org/10.1055/s-0035-1546109
Dimitrova D, Kästner AL, Kästner AN, Paping A, Henrich W, Braun T. Risk factors and outcomes associated with type of uterine rupture. Arch Gynecol Obstet. 2022;306(6):1967-77. DOI: https://doi.org/10.1007/s00404-022-06452-0
Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations. Reprod Sci. 2011;18(12):1166-85. DOI: https://doi.org/10.1177/1933719111414206
Aboshama RA, Taha OT, Halim HWA, Elrehim EIA, Kamal SHM, ElSherbiny AM, et al. Prevalence and risk factor of postoperative adhesions following repeated cesarean section: a prospective cohort study. Int J Gynecol Obstet. 2022;161(1):234-40. DOI: https://doi.org/10.1002/ijgo.14498
Jain A, Chandra R, Agarwal M, Mansoori S, Manohari N. Adhesions in repeat caesarean sections: prevalence, predictive factors, and surgical outcomes. Int J Reprod Contracept Obstet Gynecol. 2025;14(6):1873-8. DOI: https://doi.org/10.18203/2320-1770.ijrcog20251577
Hassanabad AF, Zarzycki AN, Jeon K, Deniset JF, Fedak PWM. Post-operative adhesions: a comprehensive review of mechanisms. Biomedicines. 2021;9(8):867. DOI: https://doi.org/10.3390/biomedicines9080867
Uyanikoglu H, Karahan MA, Turp AB, Agar M, Tasduzen ME, Sak S, et al. Are multiple repeated cesarean sections really as safe? J Matern Fet Neonat Med. 2016;30(4):4825. DOI: https://doi.org/10.1080/14767058.2016.1175426
Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009 Jul 1;201(1):56.e1-6. DOI: https://doi.org/10.1016/j.ajog.2009.04.039
Alshehri K, Ammar A, Aldhubabian M, Zanbaqi M, Felimban A, Alshuaibi M, et al. Outcomes and complications after repeat cesarean sections among King Abdulaziz University Hospital patients. Materia Soc Med. 2019;31(2):119. DOI: https://doi.org/10.5455/msm.2019.31.119-124
Zhou C, Zhang L, Bao Y, Li L, Zhang T, Zhang X, et al. Effect of blood transfusion during cesarean section on postpartum hemorrhage in a tertiary hospital over a 4-year period. Medicine. 2021;100(3):e23885. DOI: https://doi.org/10.1097/MD.0000000000023885
Zia S, Rafique M. Intra-operative complications increase with successive number of caesarean sections: myth or fact? Obstet Gynecol Sci. 2014;57(3):187. DOI: https://doi.org/10.5468/ogs.2014.57.3.187
Yeganegi M, Bahrami R, Azizi S, Marzbanrad Z, Hajizadeh N, Mirjalili SR, et al. Cesarean section and respiratory system disorders in newborns. Eur J Obstet Gynecol Reprod Biol X. 2024;23:100336. DOI: https://doi.org/10.1016/j.eurox.2024.100336
Gelaw KA, Aweke AM, Astawesegn FH, Demissie BW, Zeleke LB. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia. Patient Saf Surg. 2017;11(1). DOI: https://doi.org/10.1186/s13037-017-0131-3
Johnson CT, Johnson TRB, Adanu RMK. Obstetric surgery. In: Essential Surgery: Disease Control Priorities. 3rd edn. Vol. 1. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2015. DOI: https://doi.org/10.1596/978-1-4648-0346-8_ch5
Downloads
Published
How to Cite
Issue
Section
