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5 November 2012
Warning on multiple Cesar sections

A new study in BJOG: An International Journal of Obstetrics and Gynecology has compared outcomes for women having multiple repeat Caesarean sections (MRCS - defined as five or more), and women having their second to fourth caesarean section.

The researchers, from Imperial College (London) and the University of Oxford, estimate that the UK incidence of MRCS is 1.2 per 10,000 maternities. The study compared 94 women who were undergoing MRCS with 175 women having fewer caesarean sections. The results showed that women undergoing MRCS experience higher incidences of major obstetric hemorrhage, blood transfusions and admissions to a critical care setting.

Specifically, in the MRCS group, 18 percent of women had a major obstetric hemorrhage compared to less than 1 percent in women with fewer caesarean sections. In addition, 17 percent of women in the MRCS group received a blood transfusion compared to 1 percent in the comparison group.

The researchers also found that women in the MRCS group were five times more likely to have a preterm delivery with 24 percent delivering prior to 37-weeks, compared to 5 percent from the comparison group.

The study notes that the MRCS group were also more likely to have their placenta abnormally positioned in the womb during pregnancy (known as placenta praevia and placenta accrete).

"Multiple repeat caesarean sections are an unusual occurrence and for most women the outcomes are very good. However, there is a higher risk of maternal complications and preterm delivery compared to women having fewer caesareans," noted study author Mandish Dhanjal. "We also found that these risks were greatest in women undergoing MRCS who also had placenta praevia and placenta accreta. Obstetricians should be aware of this high risk group of women and work in multidisciplinary teams in order to optimize their management."

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Source: BJOG: An International Journal of Obstetrics and Gynaecology

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