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Doha, Qatar: A new study published in the Qatar Medical Journal shows that women with multiple caesareans face an increased risk of maternal surgical complications.
It also highlights that babies born to these women also show an increased risk of admission to neonatal intensive care unit (NICU) and respiratory distress syndrome (RDS).
The study based in a tertiary maternity hospital in Qatar was motivated by the increasing rates of caesarean section worldwide, fuelled in most of cases by a history of previous caesarean delivery.
Caesarean delivery (CD) accounts for nearly 1 in 5 live births worldwide and is expected to increase to almost 30% by 2030. The increasing primary caesarean rate subsequently leads to more women undergoing repeat CDs, as a previous caesarean is one of the most common indications for an elective CD.
The caesarean delivery (CD) rate in the Middle East is reported to be as high as 40.6%. Studies from Qatar report a CD risk of 25-30%, increasing to 46% in mothers with gestational diabetes. The researchers examined the health records of over 6,000 pregnant women who had one or more prior caesarean deliveries. Of these 41.3% women had a primary CD. The cohort included 30.3%, 17.5%, and 7.3% who underwent their second, third, and fourth CD. Due to the small number, women with five or more CDs were grouped contributing only 3.6%.
The study “Maternal and neonatal outcomes associated with multiple repeat caesarean deliveries: A registry-based study from Qatar” says that women with multiple caesareans face an increased risk of maternal surgical complications such as adhesions, visceral injury, pelvic haematomas, return to theatre, sepsis, and postpartum haemorrhage.
“This morbidity is notably higher in women undergoing five or more CDs, whether through elective or emergency deliveries,” it says.
According to the study, with increasing caesareans, women had a higher chance of giving birth before completing the full term of 39 weeks.
The study also highlights those neonates born to women who had multiple CDs have an increased risk of developing complications even in planned elective deliveries at term.
“It is critical to inform women about the substantial morbidity associated with multiple CDs, emphasising that while the absolute incidence is low, contraceptive advice should be offered. Given the tendency for planned early-term deliveries in this high-risk group, consideration should be given to providing antenatal corticosteroids for fetal lung maturity in this high-risk group to reduce neonatal morbidity,” the study suggests.
