Major risk factors of maternal adverse outcome in women with two or more previous cesarean sections

Amira Egić; Nataša Karadžov Orlić; Donka Mojović; Zaga Milovanović; Jovana Vučeljić; Suzana Krsmanović

doi:10.2298/VSP150428055E

Amira Egić Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Nataša Karadžov Orlić Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Donka Mojović Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Zaga Milovanović Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Jovana Vučeljić Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Suzana Krsmanović Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP150428055E

Keywords: cesarean section, morbidity, risk factors, obstetric labor complications, fetal development,

Abstract

Bacground/Aim. Maternal morbidity is defined as any condition that is attributed to or aggravated by pregnancy and childbirth that has a negative impact on the woman's wellbeing. In recent years, a growing trend of cesarean section rates can be seen throughout the world. The aim of this study was to assess factors that might have major impact on maternal adverse outcome in women with two or more previous cesarean sections. Methods. This retrospective study included women with single term pregnancy after two or more cesarean deliveries in a 10-year period (2004−2013) in the University Clinic “Narodni front” in Belgrade, Serbia. Medical records were reviewed for clinical data for maternal intraoperative and early postoperative complications regarding gestational age at delivery, the number of previous cesarean sections and mode of surgery (elective or emergency). Results. A total of 551 patients were included in the study. At 37 completed weeks delivered 14.1%, at 38 delivered 45.2% and at 39 completed weeks 40.7% patients. Women younger than 35 years more often delivered after 39 completed weeks compared with those over 35 years (69.2% vs 30.8%, p < 0.05). The overall rate of maternal complications in the study group was 16.5% with no statistical difference by gestational age at delivery. The overall rate of maternal adverse outcome was significantly less in the patients with three as compared with those with four or more cesareans (10.4% vs 66.7%, p < 0.05). There was a statistically significant difference between these groups of women regarding complications: scar dehiscence, the presence of adhesions, blood transfusion and admission in intensive care unit. Elective cesarean delivery was with less maternal complications compared with emergency cesarean deliveries (12.9% vs 27.3%, p < 0.05). Conclusion. Termination of pregnancy before completed 39 weeks does not decrease maternal morbidity. The major impact on maternal complications has the number of previous cesarean deliveries (≥ 3), as well as emergency cesarean section. Patients should be informed about potential risks for maternal health with increasing number of cesarean deliveries, especially after the first cesarean section when counseling in elective repeat cesarean vs trial of labor.

Author Biographies

Amira Egić, Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Chief of High risk pregnancy daily hospital

Nataša Karadžov Orlić, Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Head of Departmant of high risk pregnancies,

Donka Mojović, Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

MD, Departmant of high risk pregnancies, daily hospital

Zaga Milovanović, Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

MD, Departmant of high risk pregnancies, daily hospital

Jovana Vučeljić, Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

MD, Departmant of high risk pregnancies, daily hospital

Suzana Krsmanović, Obstetric and Gynecology Clinic “Narodni Front”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Resident of Department of high risk pregnancies

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