Maternal morbidity associated with multiple repeat cesarean deliveries

Robert M. Silver, Mark B. Landon, Dwight J. Rouse, Kenneth J. Leveno, Catherine Y. Spong, Elizabeth A. Thom, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M. Peaceman, Mary J. O'Sullivan, Baha Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journalArticle

852 Citations (Scopus)

Abstract

OBJECTIVE: Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries. METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002). RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively. CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, 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.

Original languageEnglish
Pages (from-to)1226-1232
Number of pages7
JournalObstetrics and Gynecology
Volume107
Issue number6
DOIs
StatePublished - Jun 1 2006
Externally publishedYes

Fingerprint

Placenta Accreta
Mothers
Morbidity
Hysterectomy
Cystotomy
Trial of Labor
Ileus
Wounds and Injuries
Operative Time
Cesarean Section
Blood Transfusion
Intensive Care Units
Ventilation
Counseling
Length of Stay
Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Silver, R. M., Landon, M. B., Rouse, D. J., Leveno, K. J., Spong, C. Y., Thom, E. A., ... Mercer, B. M. (2006). Maternal morbidity associated with multiple repeat cesarean deliveries. Obstetrics and Gynecology, 107(6), 1226-1232. https://doi.org/10.1097/01.AOG.0000219750.79480.84

Maternal morbidity associated with multiple repeat cesarean deliveries. / Silver, Robert M.; Landon, Mark B.; Rouse, Dwight J.; Leveno, Kenneth J.; Spong, Catherine Y.; Thom, Elizabeth A.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M.; O'Sullivan, Mary J.; Sibai, Baha; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

In: Obstetrics and Gynecology, Vol. 107, No. 6, 01.06.2006, p. 1226-1232.

Research output: Contribution to journalArticle

Silver, RM, Landon, MB, Rouse, DJ, Leveno, KJ, Spong, CY, Thom, EA, Moawad, AH, Caritis, SN, Harper, M, Wapner, RJ, Sorokin, Y, Miodovnik, M, Carpenter, M, Peaceman, AM, O'Sullivan, MJ, Sibai, B, Langer, O, Thorp, JM, Ramin, SM & Mercer, BM 2006, 'Maternal morbidity associated with multiple repeat cesarean deliveries', Obstetrics and Gynecology, vol. 107, no. 6, pp. 1226-1232. https://doi.org/10.1097/01.AOG.0000219750.79480.84
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstetrics and Gynecology. 2006 Jun 1;107(6):1226-1232. https://doi.org/10.1097/01.AOG.0000219750.79480.84
Silver, Robert M. ; Landon, Mark B. ; Rouse, Dwight J. ; Leveno, Kenneth J. ; Spong, Catherine Y. ; Thom, Elizabeth A. ; Moawad, Atef H. ; Caritis, Steve N. ; Harper, Margaret ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; Carpenter, Marshall ; Peaceman, Alan M. ; O'Sullivan, Mary J. ; Sibai, Baha ; Langer, Oded ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. / Maternal morbidity associated with multiple repeat cesarean deliveries. In: Obstetrics and Gynecology. 2006 ; Vol. 107, No. 6. pp. 1226-1232.
@article{4c62c2287dc74c509a1891a6e32347b0,
title = "Maternal morbidity associated with multiple repeat cesarean deliveries",
abstract = "OBJECTIVE: Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries. METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002). RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24{\%}), 49 (0.31{\%}), 36 (0.57{\%}), 31 (2.13{\%}), 6 (2.33{\%}), and 6 (6.74{\%}) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65{\%}) first, 67 (0.42{\%}) second, 57 (0.90{\%}) third, 35 (2.41{\%}) fourth, 9 (3.49{\%}) fifth, and 8 (8.99{\%}) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3{\%}, 11{\%}, 40{\%}, 61{\%}, and 67{\%} for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively. CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, 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.",
author = "Silver, {Robert M.} and Landon, {Mark B.} and Rouse, {Dwight J.} and Leveno, {Kenneth J.} and Spong, {Catherine Y.} and Thom, {Elizabeth A.} and Moawad, {Atef H.} and Caritis, {Steve N.} and Margaret Harper and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and Marshall Carpenter and Peaceman, {Alan M.} and O'Sullivan, {Mary J.} and Baha Sibai and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",
year = "2006",
month = "6",
day = "1",
doi = "10.1097/01.AOG.0000219750.79480.84",
language = "English",
volume = "107",
pages = "1226--1232",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Maternal morbidity associated with multiple repeat cesarean deliveries

AU - Silver, Robert M.

AU - Landon, Mark B.

AU - Rouse, Dwight J.

AU - Leveno, Kenneth J.

AU - Spong, Catherine Y.

AU - Thom, Elizabeth A.

AU - Moawad, Atef H.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - Carpenter, Marshall

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary J.

AU - Sibai, Baha

AU - Langer, Oded

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

PY - 2006/6/1

Y1 - 2006/6/1

N2 - OBJECTIVE: Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries. METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002). RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively. CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, 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.

AB - OBJECTIVE: Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries. METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002). RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively. CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, 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.

UR - http://www.scopus.com/inward/record.url?scp=33745616160&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745616160&partnerID=8YFLogxK

U2 - 10.1097/01.AOG.0000219750.79480.84

DO - 10.1097/01.AOG.0000219750.79480.84

M3 - Article

C2 - 16738145

AN - SCOPUS:33745616160

VL - 107

SP - 1226

EP - 1232

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 6

ER -