Abstract
Objective To estimate the risk of perioperative morbidity with increasing number of cesareans.
Study Design We conducted a retrospective cohort study from 2004 to 2010. Patients delivered by
cesarean were included. Outcome measures were a composite organ injury (bowel or bladder),
hysterectomy, hemorrhage requiring transfusion, severe morbidity, or surgical site
complications. The Cochran–Armitage's test of trend was used to assess increasing
incidence of each morbidity with number of prior cesareans. Multivariable logistic
regression was used to estimate adjusted risks for each morbidity with increasing
number of cesareans compared with primary cesarean.
Results Of the 15,872 women in the cohort, 5,144 had cesarean delivery: 3,113 primary, 1,310
one prior, 510 two prior, and 211 three or more prior cesareans. There was a significant
increase in organ injury, hysterectomy, and surgical site complications with increasing
number of cesareans. In multivariable analysis, the risk of organ injury and hysterectomy
was increased compared with primary cesarean after two prior cesareans, and after
three or more cesareans for hemorrhage requiring transfusion and surgical site complications.
Conclusion The risks of organ injury and hysterectomy are increased after two or more prior
cesareans, and risks of hemorrhage and surgical site complications are increased after
three or more cesareans.
Keywords
maternal morbidity - cesarean - complications - repeat cesarean
