ARE MULTIPLE CESAREAN-SECTIONS SAFE

To assess the maternal and neonatal risk associated with high-order ce sarean sections, a case-control study was carried out in two universit y affiliated maternity wards. The outcome of 154 pregnancies of women undergoing cesarean section for the 4th time or more was compared with 148 women sectioned for the 2nd or 3rd time and 132 women of similar age and parity after spontaneous birth. The main outcome measures were maternal operative and postoperative morbidity and neonatal prematuri ty and its complications, Apgar scores, and the need for intensive car e. Women undergoing multiple (greater than or equal to 4) cesarean sec tions had significantly more intra-abdominal adhesions (P < 0.0001) th an women sectioned for the 2nd or 3rd time. However, the time interval from incision to delivery and the total duration of operation were si milar. The postoperative course was not adversely affected by multiple cesarean sections. A high incidence (16.2%) of preterm cesarean deliv eries was noted in the study group. This was due to nonelective repeat cesarean delivery rather than to poor timing of scheduled cesarean se ctions. The significantly increased (P < 0.05) need for neonatal inten sive care was explained by the higher occurrence of prematurity. Low A pgar scores (less than or equal to 7) at 1 and 5 min were significantl y (P < 0.01) related to multiple cesarean sections, even after control ling for the effect of gestational age. We conclude that multiple cesa rean sections pose little risk for the mother, but may be associated w ith increased neonatal risk, attributed mainly to preterm non-elective cesarean sections.