Repeat c-sections raise risk of complications

NEW YORK (Reuters Health) - As the number of c-sections increases, so does the risk of bowel injury, intensive care unit admission and other maternal complications, according to a report in the medical journal Obstetrics and Gynecology.

In light of this finding, "the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery," lead author Dr. Robert M. Silver, from the University of Utah School of Medicine in Salt Lake City, and colleagues note.

The findings are based on analysis of data for 30,132 women who underwent c-section without labor in 19 academic centers from 1999 to 2002. A total of 6,201 women were having their first c-section, 15,808 were having a second, 6,324 a third, 1,452 a fourth, 258 a fifth, and 89 women already had five or more cesarean deliveries, the investigators report.

The risk of complications, including urinary or bowel injury, the need for a ventilator after delivery, ICU admission, blood transfusion of four or more units, and placenta problems were directly related to the number of previous cesarean deliveries. In addition, the length of surgery and hospital stay rose as the number of c-sections increased.

For example, the rate of placenta accreta (when the placenta implants too far into the uterus) ranged from 0.24 percent in first-time c-section patients to 6.74 percent in women who had six or more c-sections. In women with placenta previa (when the placenta implants too close to the cervix) the rates were much higher, ranging from 3 percent in first-time c-section patients to 67 percent in women who had five or more c-sections.

The hysterectomy rate was lowest in second-time c-section patients and highest in those who had at least six c-sections, ranging from 0.42 percent to 8.99 percent, respectively.

"Women planning large families should consider the risks of repeat cesarean deliveries when contemplating elective cesarean delivery or attempted vaginal birth after cesarean delivery," the authors conclude.

SOURCE: Obstetrics and Gynecology, June 2006.