Maternal Complications Increase With Multiple Cesarean Delivery
By Will Boggs, MD
NEW YORK (Reuters Health) Jul 12 - The risk of major maternal complications
increases significantly with multiple cesarean deliveries, according to
researchers based in Israel.
"We believe that a decrease in multiple cesareans is especially important
for women who desire many children," Dr. Victoria Nisenblat from Bnai-Zion
Medical Center, Haifa, told Reuters Health. "This is possible by doing the
best we can to reduce the number of first cesareans and perhaps even more
important, increasing the percentage of vaginal births after cesareans in
such populations."
Dr. Nisenblat and colleagues evaluated the maternal complications associated
with three or more repeat cesarean deliveries compared with those associated
with a second planned repeat cesarean delivery by examining medical records
of women who underwent repeat cesarean deliveries at their hospital.
The 277 women in the multiple-cesarean group were significantly more likely
to have excessive blood loss, difficult delivery of the neonate, and dense
adhesions than were the 491 women in the second-cesarean group.
These differences persisted after adjustment for maternal age, parity, and
gestational age, the authors report in the July issue of Obstetrics &
Gynecology.
The proportion of women having any major complication was significantly
higher in the multiple-cesarean group (8.7%) than in the second-cesarean
group (4.3%), the researchers note, though minor and major postoperative
complications were not significantly different between the two groups.
"When, after the first cesarean, the route of delivery is discussed with the
patient, the doctor should take into consideration the family planning of
this specific woman," Dr. Nisenblat said. "In the case of additional
pregnancies planned, the a vaginal birth after cesarean trial should be
proposed."
"We are completing a longitudinal study comparing the outcome and
complications in the second and third delivery post-cesarean, of women who
on their first-post cesarean delivery underwent a trial of labor compared
with women who underwent an elective cesarean delivery," Dr. Nisenblat
added.
Obstet Gynecol 2006;108:21-26.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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