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Maternal morbidity rises sharply with repeat cesareans: largest increase seen after fourth delivery.(News)
RENO, NEV. -- Maternal morbidity increases significantly with each subsequent cesarean delivery, according to a large prospective cohort study reported by Robert M. Silver, M.D., at the annual meeting of the Society for Maternal-Fetal Medicine.
Moreover, morbidity rates show a particularly large increase with the fourth and subsequent cesarean deliveries, according to the study, which was based on data from the Maternal Fetal Medicine Units (MFMU) Network, created by the National Institute of Child Health and Human Development.
The central conclusion of this study is that "the number of intended pregnancies should be factored into consideration of primary elective cesarean delivery or attempted vaginal birth after cesarean," said Dr. Silver of the University of Utah, Salt Lake City.
In addition, the study suggests that physicians should give serious thought to a trial of labor in women who are candidates for a first cesarean delivery and who are planning to have several children.
Of the 378,168 births followed prospectively by the 14 tertiary care centers in the MFMU Network, there was a total of 57,068 cesarean deliveries. Dr. Silver's study focused on the 30,132 cesarean deliveries that were not accompanied by a trial of labor. More than 6,000 women who participated in the study were having at least their third cesarean delivery. And more than 1,800 women were having their fourth or more than fourth cesarean delivery, making this by far the largest study of its kind.
Several morbidities increased significantly with each subsequent cesarean delivery. (See table.) These ...
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