Pregnancy following five previous cesarean sections: a rare case of successful emergency repeat cesarean

Abstract

Pregnancy following multiple previous cesarean sections is associated with significantly increased maternal and fetal morbidity. Grand multiparous Women with five or more prior lower segment cesarean sections (LSCS) constitute a particularly high-risk obstetric group due to increased chances of dense intra-abdominal adhesions, scar dehiscence, placenta previa, placenta accreta spectrum, classical ceasrean, hemorrhage, bladder injury, bowel injury, and uterine rupture. We report a rare case of a successful emergency classical ceserean section in a grand multiparous unbooked patient with five previous LSCS presenting with abdominal pain and scar tenderness at term gestation. A live male baby weighing 2.170 kg was delivered with Apgar scores of 7 and 9 at one and five minutes, respectively. Bilateral tubal ligation was performed. Management becomes challenging in unbooked patients presenting late in pregnancy or in labour. Despite multiple risk factors favorable maternal and neonatal outcome was achieved with timely diagnosis, careful perioperative planning, and multidisciplinary management.