1887
Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery, particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs.Methods: This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs, with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications, blood loss, and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth, neonatal ICU (NICU) admission, respiratory distress syndrome (RDS), and perinatal death.Results: Of the 6,316 women in the study, 2,608 (41.3%) had a primary CD. 30.3%, 17.5%, and 7.3% of the cohort had their second, third, and fourth CDs, respectively. Women undergoing the 5th CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1%, p = 0.015) and postpartum hemorrhage (7.5%, p = 0.010). 24% of babies in Group 5 were born preterm (p < 0.001). They also had a 3.5 times higher risk of having a surgical complication (RR = 3.5, 95% CI 1.6-7.6, p = 0.002), a 1.8 times higher risk of developing postpartum hemorrhage (RR = 1.8, 95% CI 1.1-2.9, p = 0.014), a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR = 1.7, 95% CI 1.3-2.2, p < 0.001), a higher risk of the baby getting admitted to NICU (RR = 1.3, 95% CI 1.0-1.6, p = 0.038), and developing RDS (RR = 1.5, 95% CI 1.2-2.0, p = 0.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9, 95% CI 2.1-4.0) and RDS (RR 3.5, 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p < 0.001 for both).Conclusion: Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups—consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2024.3
2024-01-11
2024-07-16
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2024/1/qmj.2024.3.html?itemId=/content/journals/10.5339/qmj.2024.3&mimeType=html&fmt=ahah

References

  1. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021 Jun; 6:(6):e005671. doi:10.1136/bmjgh-2021-005671.
    [Google Scholar]
  2. Field A, Mbbs B, Mrcog P, Haloob R. Complications of caesarean section. Obstet Gynaecol. 2016; 18:(4):265–72. doi:10.1111/tog.12280.
    [Google Scholar]
  3. Antoine C, Young BK. Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly. J Perinat Med. 2020 Sep 4; 49:(1):5–16. doi:10.1515/jpm-2020-0305.
    [Google Scholar]
  4. Panda S, Begley C, Corcoran P, Daly D. Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study. Birth. 2022 Dec; 49:(4):812–822. doi:10.1111/birt.12654.
    [Google Scholar]
  5. Omar AAA, Anza SHA. Frequency Rate and Indications of Caesarean Sections at Prince Zaid Bin Al Hussein Hospital-Jordan. JRMS. 2012; 19:(1):82–6.
    [Google Scholar]
  6. Nwobodo EI, Isah AY, Panti A. Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria. Niger Med J. 2011 Oct; 52:(4):263–5. doi:10.4103/0300-1652.93801.
    [Google Scholar]
  7. United Nations. Population Division Data Portal [Internet]. [cited 2023 May 8]. Available from: https://population.un.org/dataportal/data/indicators/19/locations/935,5500/start/1990/end/2023/table/pivotbylocation.
  8. Bashir M, Baagar K, Naem E, Elkhatib F, Alshaybani N, Konje JC, et al. Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar. BMJ Open. 2019 Feb 19; 9:(2):e023612. doi:10.1136/bmjopen-2018-023612.
    [Google Scholar]
  9. Shaukat S, Nur U. Effect of prepregnancy maternal BMI on adverse pregnancy and neonatal outcomes: results from a retrospective cohort study of a multiethnic population in Qatar. BMJ Open. 2019 Sep 1; 9:(9):e029757. doi:10.1136/bmjopen-2019-029757.
    [Google Scholar]
  10. Gasim T, Al Jam FE, Rahman MS, Rahman J. Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome. J Reprod Med. 2013 Jul-Aug; 58:(7–8):312–8.
    [Google Scholar]
  11. Cook JR, Jarvis S, Knight M, Dhanjal MK. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG. 2013 Jan; 120:(1):85-91. doi:10.1111/1471-0528.
    [Google Scholar]
  12. Friedman AM, Ananth C V., Siddiq Z, D'Alton ME, Wright JD. 672: Neonatal outcomes after high-order cesarean delivery. Am J Obstet Gynecol. 2016 Jan 1; 214:(1):S355–6. doi:10.1016/j.ajog.2015.10.719.
    [Google Scholar]
  13. Klahr R, Cheung K, Markovic ES, Naert M, Rebarber A, Fox NS. Maternal Morbidity with Repeated Cesarean Deliveries. Am J Perinatol. 2023 Oct; 40:(13):1431–1436. doi:10.1055/s-0041-1736183.
    [Google Scholar]
  14. World Healt Organization. Preterm birth [Internet]. [cited 2022 Sep 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth.
  15. StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.; 2019.
  16. Shittu S, Alansari L, Nattouf F, Olukade T, Abdallah N. Impact of maternal nationality on caesarean section rate variation in a high-income country. Qatar Med J. 2021 Nov 28; 2021:(3):69. doi:10.5339/qmj.2021.69.
    [Google Scholar]
  17. Osman S, Farid G, Kamal RM, Ali SR, Swaraldahab MAH. Perinatal Morbidity & Mortality following repeat Cesarean section due to five or more previous Cesarean Section done in Tertiary centre in KSA. Clin J Obstet Gynecol. 2018; 1:(2):45–51.
    [Google Scholar]
  18. Kaplanoglu M, Bulbul M, Kaplanoglu D, Bakacak SM. Effect of multiple repeat cesarean sections on maternal morbidity: data from southeast Turkey. Med Sci Monit. 2015 May 20;21:1447–53. doi:10.12659/MSM.893333.
    [Google Scholar]
  19. Nisa MU, Tassaduq M, Sajjad A, Sajjad M, Aslam AS. Maternal morbidity of higher order cesarean sections: An analytical study at sir ganga ram hospital Lahore. Pakistan J Med Heal Sci. 2020; 14:(4).
    [Google Scholar]
  20. Abdelazim I, Alanwar A, Shikanova S, Kanshaiym S, Farghali M, Mohamed M, et al.. Complications associated with higher order compared to lower order cesarean sections. J Matern Fetal Neonatal Med. 2020 Jul; 33:(14):2395-2402. doi:10.1080/14767058.2018.1551352.
    [Google Scholar]
  21. ACOG Committe. Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol. 2019 Jan; 133:(1):e73–e77. doi:10.1097/AOG.0000000000003006.
    [Google Scholar]
  22. Kamath BD, Todd JK, Glazner JE, Lezotte D, Lynch AM. Neonatal outcomes after elective cesarean delivery. Obstet Gynecol. 2009 Jun; 113:(6):1231–1238. doi:10.1097/AOG.0b013e3181a66d57.
    [Google Scholar]
  23. Tefera M, Assefa N, Mengistie B, Abrham A, Teji K, Worku T. Elective Cesarean Section on Term Pregnancies Has a High Risk for Neonatal Respiratory Morbidity in Developed Countries: A Systematic Review and Meta-Analysis. Front Pediatr. 2020 Jun 25;:8:286. doi:10.3389/fped.2020.00286.
    [Google Scholar]
  24. Tita ATN, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med. 2009 Jan 8; 360:(2):111–20. doi:10.1056/NEJMoa0803267.
    [Google Scholar]
  25. Shinar S, Walsh L, Roberts N, Melamed N, Barrett J, Riddell C, et al. Timing of cesarean delivery in women with ≥ 2 previous cesarean deliveries. Am J Obstet Gynecol. 2022 Jan; 226:(1):110.e1–110.e10. doi:10.1016/j.ajog.2021.07.018.
    [Google Scholar]
  26. Stock SJ, Thomson AJ, Papworth S. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG An Int J Obstet Gynaecol. 2022 Jul; 129:(8):e35–e60. doi:10.1111/1471-0528.17027.
    [Google Scholar]
  27. Sotiriadis A, McGoldrick E, Makrydimas G, Papatheodorou S, Ioannidis JP, Stewart F, et al. Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes. Cochrane Database Syst Rev. 2021 Dec 22;12:(12):CD006614. doi:10.1002/14651858.CD006614.pub4.
    [Google Scholar]
  28. Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ. 2016 Oct 12; 355::i5044. doi:10.1136/bmj.i5044.
    [Google Scholar]
  29. Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more? BJOG. 2004 Oct; 111:(10):1090–4. doi:10.1111/j.1471-0528.2004.00244.x.
    [Google Scholar]
/content/journals/10.5339/qmj.2024.3
Loading
/content/journals/10.5339/qmj.2024.3
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error