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Lee KS, Wang YL, Huang WC, Yang JH, Huang JP. Limited efficacy with additional adverse effect of anti-adhesion barrier at primary cesarean section. J Formos Med Assoc 2021; 121:227-236. [PMID: 33838986 DOI: 10.1016/j.jfma.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/PURPOSE In our experience, adhesion after the primary CS is generally minimal or nonexistent. However, adhesion barriers users have experienced more febrile episodes that may require therapeutic antibiotics during the postcesarean period. We evaluated clinical efficacy of HA-CMC and ORC to prevent adhesion at secondary CS and the post-operative outcome at primary and secondary CS. METHODS This retrospective study includes 199 Asian women undergoing primary and secondary cesarean section between January1, 2011, and September 31, 2019. We used linear and logistic regression to analyze risk factors of postcesarean fever. An interaction term analysis was performed to examine the effect of surgical site infection risk factors and use of adhesion barrier on postcesarean fever rates. RESULTS We found that use of adhesion barrier at the primary cesarean section is associated with a significantly higher incidence of postcesarean fever (p = 0.045), which is an independent risk factor of postcesarean fever (adjusted hazard ratio (Adj-HR)= 3.53, 95% CI = 1.03-10.24, p = 0.045). The strongest risk factor for postcesarean fever is the use of anti-adhesion film during emergency cesarean section (p = 0.041). In the subgroup of labor before operation and emergency cesarean section, adhesion barrier user had significant higher risk of postcesarean fever than nonuser (p = 0.018, Adj-HR = 12.12, 95% CI = 1.53-95.78; emergency cesarean section: p = 0.016, Adj-HR = 12.71, 95% CI = 1.62-99.62). CONCLUSION Use of anti-adhesion films during emergency cases and with a significantly higher risk of postcesarean fever which potentially means increased risk of surgical site infection. Therefore, we do not suggest routine application of anti-adhesion films during cesarean deliveries especially in emergency cesarean section or in a woman having labor before operation.
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Affiliation(s)
- Kuan-Sheng Lee
- Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan.
| | - Yeou-Lih Wang
- Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan.
| | - Wen-Chu Huang
- Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan.
| | - Jia-Hwa Yang
- Taiwan Public Health Association, Taipei 100, Taiwan.
| | - Jian-Pei Huang
- Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan.
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Saban A, Shoham-Vardi I, Yohay D, Weintraub AY. Peritoneal adhesions do not increase intra-operative organ injury or adverse neonatal outcomes during a repeated cesarean delivery. Arch Gynecol Obstet 2020; 302:879-886. [PMID: 32666127 DOI: 10.1007/s00404-020-05676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine whether the presence of peritoneal adhesions at the second cesarean delivery (CD), attributable to the first CD, are associated with maternal intra-operative organ injury and adverse neonatal outcomes. METHODS A retrospective cohort study was conducted, comparing severe maternal intra-operative organ injury and adverse neonatal outcomes, between women with and without peritoneal adhesions. All women with two CDs during the follow-up period were included. Women with adhesions diagnosed during the first CD, history of other abdominal or pelvic surgery, pelvic infection or pelvic inflammatory disease, endometriosis, uterine Mullerian anomalies and newborns with known chromosomal or structural abnormalities were excluded, resulting in 7925 women. Intra-operative peritoneal organ injury was defined as a composite of bladder injury, ureteral injury, small bowel injury or hysterectomy. The examined adverse neonatal outcomes were low 1 and 5 min Apgar scores, intrapartum death (IPD) and postpartum death (PPD). Multivariate logistic regression was performed. RESULTS Peritoneal adhesions at the second CD, attributable to the first CD were diagnosed in 32.6% of patients (n = 2581). The presence of peritoneal adhesions was not found to be independently associated with intra-operative organ injury nor with 5 min Apgar scores, IPD and PPD. Second CDs complicated with adhesions were found to be associated with low (< 7) 1 min Apgar scores (adjusted OR 1.38, CI 1.20-1.58, p < 0.001). CONCLUSION Adhesions attributable to a previous CD do not seem to increase the risk for intra-operative organ injury and adverse neonatal outcomes. These findings may assist in reassuring patients who are facing a second CD.
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Affiliation(s)
- Alla Saban
- Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Ilana Shoham-Vardi
- Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Alshehri KA, Ammar AA, Aldhubabian MA, Al-Zanbaqi MS, Felimban AA, Alshuaibi MK, Oraif A. Outcomes and Complications After Repeat Cesarean Sections Among King Abdulaziz University Hospital Patients. Mater Sociomed 2019; 31:119-124. [PMID: 31452637 PMCID: PMC6690310 DOI: 10.5455/msm.2019.31.119-124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cesarean section (CS) is a surgical procedure that often saves the lives of both the mother and the baby, while a previous CS is one of the main indications for cesarean delivery in current pregnancy. AIM Our aim was to determine the surgical and obstetrical outcomes and complication for the mother and the neonate after 4 or more CSs and compare it with mothers who had less than 4 previous CSs. METHODS This case-control study was conducted by reviewing the records of all women who underwent multiple CSs from 2013 to 2018. Our study group comprised of 394 women who had 4 or more CSs, and our control group comprised of similar number of women who had previous history of two or three CSs. RESULTS A total of 788 patients were enrolled in our study. We found that adhesions were the most common complications in our study group with a considerable increase in number of both moderate and severe adhesions in the study group compared to the controls with p-value of <0.001. CONCLUSION Increasing number of CSs leads to an increase of the complications risk. Among the complications, adhesions were the most common in our study group, followed by intraoperative bleeding.
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Affiliation(s)
- Khalid A Alshehri
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Ammar
- College of Medicine, Jeddah University, Jeddah, Saudi Arabia
| | | | | | - Ahyad A Felimban
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Motaz K Alshuaibi
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayman Oraif
- Department of Obstetrics and Gynecology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Kahyaoglu I, Kayikcioglu F, Kinay T, Mollamahmutoglu L. Abdominal scar characteristics: do they predict intra-abdominal adhesions with repeat cesarean deliveries? J Obstet Gynaecol Res 2015; 40:1643-8. [PMID: 24888928 DOI: 10.1111/jog.12429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to evaluate the relation between abdominal scar characteristics and the severity of intra-abdominal adhesions with repeat cesarean deliveries. METHODS A total of 208 women with at least one previous cesarean delivery at or beyond 37 weeks of gestation who were admitted for repeat cesarean delivery were enrolled in this study. Scars were categorized as depressed, flat or elevated according to their appearance, and hyperpigmented or the same color as the surrounding skin according to their pigmentation status. Intraoperative adhesions were graded according to the modified Nair's classification and categorized as no adhesion, filmy or dense adhesions. RESULTS No significant difference was found between women with or without adhesions regarding age, body mass index, gestational week at delivery, number of previous cesarean deliveries or the duration since the last cesarean delivery. Women with depressed scars had more intra-abdominal adhesions than women with flat or elevated abdominal scars (P = 0.013). There was no significant difference in the incidence of hyperpigmented and non-pigmented scars between women with or without adhesions (39.4% vs 41.3% and 60.6% vs 58.7%, respectively) (P > 0.05). Scar width was significantly larger in patients with intra-abdominal adhesions than in patients without adhesions (3.6 ± 1.1 vs 3.2 ± 0.9) (P = 0.003), whereas scar length did not differ significantly (15.2 ± 1.3 vs 15.1 ± 2.1) (P > 0.005). CONCLUSION There is a relation between depressed abdominal scars and intra-abdominal adhesions, whereas pigmentation status does not differ between women with or without adhesions.
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Affiliation(s)
- Inci Kahyaoglu
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
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Moro F, Mavrelos D, Pateman K, Holland T, Hoo WL, Jurkovic D. Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:223-228. [PMID: 25042444 DOI: 10.1002/uog.14628] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/11/2014] [Accepted: 07/02/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate the prevalence and location of pelvic adhesions in women with a history of Cesarean section and to identify risk factors for their formation and symptoms associated with their presence. METHODS This was a prospective observational study of women in whom one or more Cesarean sections had been performed > 12 months previously and who attended for a gynecological ultrasound examination. In all women, both transvaginal and transabdominal scans were performed in order to identify the presence of pelvic adhesions. Medical and surgical history was recorded and a structured questionnaire was used to enquire about any history of pelvic pain and urinary symptoms. RESULTS A total of 308 women were recruited into the study. On ultrasound examination, 139 (45.1% (95% CI, 39.7-50.7%)) women showed evidence of adhesions within the pelvis. Adhesions in the vesicouterine pouch were the most common and were found in a total of 79 (25.6% (95% CI, 20.7-30.5%)) women. In women with a history of no surgery other than Cesarean section(s) (n = 220), an increasing number of Cesarean sections (odds ratio (OR) 3.4 (95% CI, 2.1-5.5)) and a postoperative wound infection (OR 11.7 (95% CI, 3.5-39.5)) increased the likelihood of adhesions developing in the anterior pelvic compartment. There was a significant association between the presence of anterior compartment adhesions and chronic pelvic pain. Multivariable logistic regression analysis identified anterior abdominal wall adhesions (OR 2.4 (95% CI, 1.0-5.9)) and any adhesions present on ultrasound scan (OR 2.6 (95% CI, 1.2-5.7)) as independent predictors of chronic pelvic pain. CONCLUSIONS Pelvic adhesions are present in more than a third of women with a history of Cesarean section and they are associated with chronic pelvic pain.
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Affiliation(s)
- F Moro
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK
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Adhesion prevention after cesarean delivery: evidence, and lack of it. Am J Obstet Gynecol 2014; 211:446-52. [PMID: 24858198 DOI: 10.1016/j.ajog.2014.05.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 11/21/2022]
Abstract
In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery.
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Gedikbasi A, Akyol A, Bingol B, Cakmak D, Sargin A, Uncu R, Ceylan Y. Multiple Repeated Cesarean Deliveries: Operative Complications in the Fourth and Fifth Surgeries in Urgent and Elective Cases. Taiwan J Obstet Gynecol 2010; 49:425-31. [DOI: 10.1016/s1028-4559(10)60093-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2009] [Indexed: 10/18/2022] Open
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Wilson S, Fecho K, Marshall J, Spielman F. Factors influencing cesarean delivery operative times: a prospective observational cohort study. Int J Obstet Anesth 2010; 19:417-21. [DOI: 10.1016/j.ijoa.2010.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 04/09/2010] [Accepted: 06/19/2010] [Indexed: 11/27/2022]
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Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009; 201:56.e1-6. [PMID: 19576375 DOI: 10.1016/j.ajog.2009.04.039] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 04/20/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the development and implications of intraabdominal adhesions after repeat cesarean section delivery (CS). STUDY DESIGN We reviewed the charts of 1283 women who underwent repeat CS and 203 other women who underwent primary CS. Primary outcome measures were incidence and extent of adhesions, incision-to-delivery interval, and operating time. RESULTS No adhesions were found in primary CS. Compared with those women with a second CS (24.4%), significantly more women had adhesions after 3 CSs (42.8%; 95% confidence interval [CI], 0.84-0.99). Compared with a first CS (7.7 +/- 0.3 minutes), the delivery time was significantly longer at subsequent CSs (second CS, 9.4 +/- 0.1 minutes; 95% CI, 1-2; third CS, 10.6 +/- 0.3 minutes; 95% CI, 2-4; >or= 4 CSs, 10.4 +/- 0.1 minutes; 95% CI, 1-2). However, complication rates in those women with >or= 2 CSs were comparable with primary CS. CONCLUSION Increased adhesion development and a longer time to delivery were found with each subsequent CS.
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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. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107:1226-32. [PMID: 16738145 DOI: 10.1097/01.aog.0000219750.79480.84] [Citation(s) in RCA: 1025] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Nisenblat V, Barak S, Griness OB, Degani S, Ohel G, Gonen R. Maternal Complications Associated With Multiple Cesarean Deliveries. Obstet Gynecol 2006; 108:21-6. [PMID: 16816051 DOI: 10.1097/01.aog.0000222380.11069.11] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The claim that a planned repeat cesarean delivery is safer than a trial of labor after cesarean may not be applicable to women who desire larger families. The aim of this study was to assess maternal complications after multiple cesarean deliveries. METHODS The records of women who underwent two or more planned cesarean deliveries between 2000 and 2005 were reviewed. We compared maternal complications occurring in 277 women after three or more cesarean deliveries (multiple-cesarean group) with those occurring in 491 women after second cesarean delivery (second-cesarean group). RESULTS Excessive blood loss (7.9% versus 3.3%; P < .005), difficult delivery of the neonate (5.1% versus 0.2%; P < .001), and dense adhesions (46.1% versus 25.6%; P < .001) were significantly more common in the multiple-cesarean group. Placenta accreta (1.4%) and hysterectomy (1.1%) were more common, but not significantly so, in the multiple-cesarean group. The proportion of women having any major complication was higher in the multiple-cesarean group, 8.7% versus 4.3% (P = .013), and increased with the delivery index number: 4.3%, 7.5%, and 12.5% for second, third, and fourth or more cesarean delivery, respectively (P for trend = .004). CONCLUSION Multiple cesarean deliveries are associated with more difficult surgery and increased blood loss compared with a second planned cesarean delivery. The risk of major complications increases with cesarean delivery number. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Victoria Nisenblat
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
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Moodliar S, Moodley J, Esterhuizen TM. Complications associated with caesarean delivery in a setting with high HIV prevalence rates. Eur J Obstet Gynecol Reprod Biol 2006; 131:138-45. [PMID: 16806653 DOI: 10.1016/j.ejogrb.2006.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 03/08/2006] [Accepted: 05/04/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was designed to determine the prevalence of complications associated with abdominal delivery in a setting of high caesarean section (C/S) and HIV rates. METHOD A detailed review of the records of 737 C/S performed over a three-month period was conducted in a tertiary teaching hospital in Durban, South Africa. RESULTS The overall complication rate was 14.2%. Major complications included endometritis, wound sepsis, post-partum haemorrhage and bladder injury. HIV infection may have a negative impact on morbidity rates. Disimpacting the fetal head vaginally had a significant association with endometritis (p=0.021). The use of a corrugated drain did not prevent wound sepsis (p<0.001). CONCLUSION Complications associated with C/S are common is a setting of high C/S rates and HIV infection.
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Affiliation(s)
- S Moodliar
- Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Sobande A, Eskandar M. Multiple Repeat Caesarean Sections: Complications and Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:193-197. [PMID: 16650356 DOI: 10.1016/s1701-2163(16)32105-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the complications and outcomes of Caesarean section (CS) in women who have had three or more previous lower segment Caesarean sections with those in women with one previous CS. METHODS We performed a retrospective study of 371 patients undergoing repeat CS. Of these, 115 (31%) had previously had three or more Caesarean sections (group 1) and 256 (69%) had previously had one CS (group 2). All 371 patients had the repeat CS performed at Abha Maternity Hospital, Saudi Arabia between June 2002 and May 2004. Demographic data, complications, and outcomes were compared using the Student t and chi-square tests. RESULTS There were statistically significant differences between the two groups with respect to mean maternal age, parity, gestation at delivery, and experience of the surgeon (P < 0.05). CS was performed as an emergency in 38 (32.9%) and 186 (72.6%) of patients in groups 1 and 2 respectively (P < 0.05). The consultant was involved in the decision to perform CS in 215 (84.6%) of patients with one previous CS. There were significant differences between the two groups in the type of skin incision, the presence of dense adhesions during surgery, and bladder injury (P < 0.05). There were no statistically significant differences in birth weight, stillbirth rate, low Apgar score, blood loss during surgery, duration of surgery, or the duration of postoperative hospital stay. CONCLUSION The prevalence of dense intra-abdominal adhesions and of bladder injury during CS was higher in women with a history of three or more previous CS than in women with one previous CS. Placenta previa and Caesarean hysterectomy occurred with equal frequency in each group, and wound dehiscence and uterine rupture were rare.
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Affiliation(s)
- Adekunle Sobande
- Department of Obstetrics and Gynaecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mamdoh Eskandar
- Department of Obstetrics and Gynaecology and Reproductive Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. Multiple cesarean section morbidity. Int J Gynaecol Obstet 2005; 87:227-32. [PMID: 15548394 DOI: 10.1016/j.ijgo.2004.08.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 08/09/2004] [Accepted: 08/13/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify maternal risk associated with multiple cesarean sections (CSs) and determine whether the third CS defines a threshold for increased morbidity. METHODS From January 1997 to January 2002, the clinical records of 3191 women who were delivered by CS at our referral maternity center were examined for selected indicators of maternal morbidity. The women were assigned to groups based on number of CSs and the frequency of each indicator was determined. A composite score for each indicator among women grouped by number of consecutive CSs was then derived to compare risk between groups and against the third CS. RESULTS By all indicators studied, morbidity increased with successive CSs before and through the third CS. However, compared with the third, the risk of major morbidity was significantly increased with the fifth, and much worse at the sixth CS for placenta previa (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.9-7.4), placenta accreta (OR=6.1, 95% CI=2.0-18.4) and hysterectomy (OR=5.9, 95% CI=1.5-24.4). But the third and fourth CSs had the same risk of major morbidity for placenta previa (OR=1.4, 95% CI=0.8-2.2), placenta accreta (OR=1.0, 95% CI=0.3-2.9) and hysterectomy (OR=0.3, 95% CI=0.0-2.7). CONCLUSIONS The third CS does not define a threshold for increased risk to the mother. Instead, overall morbidity rises continually with each successive CS. However, specifically for major morbidity from the triad of placenta previa, placenta accreta and hysterectomy during CS, the fourth CS carries the same risk as the third.
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Affiliation(s)
- F W Makoha
- Department of Obstetrics and Gynecology, Maternity and Children's Hospital, Jeddah, Saudi Arabia.
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Uygur D, Gun O, Kelekci S, Ozturk A, Ugur M, Mungan T. Multiple repeat caesarean section: is it safe? Eur J Obstet Gynecol Reprod Biol 2005; 119:171-5. [PMID: 15808374 DOI: 10.1016/j.ejogrb.2004.07.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 06/15/2004] [Accepted: 07/23/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the obstetric outcome of patients without obstetric risks, who had two or more previous caesarean sections (C/S) prior to the current pregnancy, which was managed by caesarean section in our obstetric department. METHODS We studied the case notes of 602 women who had a repeat caesarean section in our unit between May 2002-June 2003. We then compared the two groups: (1) those who had two or more previous caesarean sections and (2) those who had only one previous caesarean section. RESULTS In the study group, while dense intraperitoneal adhesions were present in 3.6% of the patients, they were not found in control group. This difference was statistically significant (P < 0.05). Uterine wound separation rate was 1.9% in the study group and none of the patients in control group had uterine wound separation, which was statistically significant also (P < 0.05). There was no statistically significant association between Apgar scores and number of previous caesarean sections. Postoperative complication rates did not differ between the two groups (P > 0.05). CONCLUSION Patients without any obstetric risks, with two or more previous caesarean sections had significantly more dense adhesions and uterine wound separations in the current caesarean section compared to patients with one previous caesarean section. But, maternal and fetal mortality and morbidity in women who have two or more previous caesarean sections did not differ from the patients with one previous caesarean section.
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Affiliation(s)
- Dilek Uygur
- Zekai Tahir Burak Women's Hospital, Gynecology and Obstetrics, 33 Cadde, 16/27 Fatih Sultan Me., Karakusunlar, Cankaya, 06520 Ankara, Turkey.
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17
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Abstract
OBJECTIVE To determine the maternal morbidity and mortality associated with multiple repeat caesarean sections. DESIGN Retrospective study. SETTING Security Forces Hospital serving Ministry of Interior and Security Forces personnel in Riyadh, Kingdom of Saudi Arabia. POPULATION Three hundred and eight case records undergoing between fifth and ninth caesarean section (mean 7) were studied and compared with a control group of 306 patients undergoing third or fourth caesarean section during the period January 1994-December 2002. MAIN OUTCOME MEASURE Operative and post-operative complications and difficulties. RESULTS Five or more caesarean sections were associated with a longer operating time as well as an increased rate of severe adhesions. Blood transfusion rate was similar in the two groups but a drop of pre-operative to post-operative haemoglobin was significantly higher in the study group compared with the controls. There was no significant difference in the Apgar score of the baby, neonatal admission rate, incidence of caesarean hysterectomy, uterine scar rupture, placenta praevia, placenta accreta, bladder injury, incidence of postpartum pyrexia, wound infection and urinary tract infection between the two groups. There was no maternal death in the study group but one mother died in the control group. CONCLUSION The higher order (5-9) repeat caesarean sections carry no specific additional risk for the mother or the baby when compared with the lower order (3 or 4) repeat caesarean sections.
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Affiliation(s)
- Mumtaz Rashid
- Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
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18
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Abstract
BACKGROUND Multiple repeat cesarean delivery is common in many parts of Saudi Arabia. We conducted a retrospective analysis of patient records to determine the major and minor complications as well as the neonatal outcome associated with multiple repeat cesarean sections. METHODS We analyzed relationships between the number of cesarean sections and various demographic and clinical variables in 150 patients undergoing 4 to 8 cesarean sections (mean 6.0) compared with a control group of 140 patients undergoing 2 to 3 cesarean sections (mean 2.5) during the period from 1996 to 2000 at the Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS Both the gestation age of the mother and birth weight of the baby were lower in the study group compared with the control group (mean gestation age 36 weeks in the study group compared with 37 weeks in the control group (P=0.001), and mean birth weight 2.9 kg for infants in the study group compared with 3.1 kg in the control group (P=0.01). The total duration of the operation was longer in the study group (63 minutes on average) compared with the control (45 minutes on average) (P=0.001). There were 80 cases of severe adhesion encountered during surgery in the study group compared with 40 cases in the control group (P=0.001). There was no difference in the Apgar score of the baby and the neonatal admission rate in the two groups. The incidence of cesarean hysterectomy, uterine scar dehiscence, placenta placenta previa, placenta accreta and bladder injury was similar in two groups. The incidence of post partum pyrexia, wound infection, urinary tract infection, and blood transfusion was also comparable in the two groups. CONCLUSION No specific additional risk is associated with higher order (four to eight) repeat cesarean sections that is not normally encountered with lower order (two to three) repeat cesarean sections.
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Affiliation(s)
- Tariq Y Khashoggi
- Department of Obstetrics and Gynecology, King Saud University, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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