Asakura HS, Myers A. More than one previous cesarean delivery: a 5-year experience with 435 patients

Department of Obstetrics and Gynecology, Mount Sinai Hospital Medical Center, Chicago Medical School, Illinois, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 06/1995; 85(6):924-9. DOI: 10.1016/0029-7844(95)00078-6
Source: PubMed


To evaluate the obstetric outcome of patients who have had more than one previous cesarean delivery, and to compare it with that of patients with one previous cesarean.
Medical records of 435 women with more than one previous cesarean and 1206 with one previous cesarean, and who delivered at our institution in the period 1987-1991, were reviewed retrospectively. All adverse outcomes related to uterine wound separation identified in medical records were reviewed individually. Statistical analysis of outcome used chi 2 test, Fisher exact test, and odds ratios with 95% confidence intervals.
Uterine wound separation occurred in nine of 435 patients with more than one previous cesarean compared with 16 of 1206 with a single previous cesarean (2.1 versus 1.3%, not significant). Of those undergoing a trial of labor, separations occurred in six of 302 and 12 of 1110 patients with more than one and a single previous operation, respectively (2.0 versus 1.1%, not significant). Vaginal birth after cesarean was successful less often in women with more than one previous cesarean than in those with one previous operation (64 versus 77%, P < .05). Important adverse outcomes were infrequent and not related to the number of previous cesareans.
Our findings support allowing a trial of labor for patients with more than one previous cesarean delivery under conditions that permit prompt recognition and treatment of emergencies.

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Available from: Stephen A Myers, Jul 31, 2014
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    • "Although Asakura and Myers [4] found no significant difference in the risk of uterine rupture or dehiscence between those with more than one cesarean and the other group of only previous one cesarean (OR 1.58, 95% C.I. {0.69-3.62}) five hysterectomies were done in the first group versus only one in the second group (P < 0.05). "
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    ABSTRACT: To test the concept that increasing the number of repeated cesarean deliveries increases the maternal and neonatal risks, a case control study comparing patients delivered by repeat cesarean sections following more than 3 previous cesareans (Group A) with those following 2 or 3 previous cesareans (Group B) was conducted at King Abdulaziz University Hospital. The maternal characteristics, associated complications, and the neonatal outcome were compared between the two groups. Statistical analyses were done with Statistical Package for the Social Sciences for Windows 10 (SPSS Inc., Chicago, IL), and logistic regression for clinical variables by means of SAS. 98 patients (Group A) were compared with 101 patients (Group B). Whereas, more patients of Group A required blood transfusions than patients in Group B (P < 0.01), all other post-operative maternal morbidity, major operative complications, and neonatal outcome were not statis-tically different between the two groups (P > 0.05 in all variables). Although there was a clinical trend towards increasing the risk to mother or fetus by increasing the number of cesareans, this was not statistically significant.
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    ABSTRACT: Uterine rupture may be defined as a disruption of the uterine muscle extending to and involving the uterine serosa or disruption of the uterine muscle with extension to the bladder or broad ligament [1]. Uterine dehiscence is defined as disruption of the uterine muscle with intact uterine serosa [1]. Uterine rupture is associated with severe maternal and perinatal morbidity and mortality, and it remains one of the most catastrophic obstetrical emergencies. It has consequences not only for the index pregnancy but also, if it is possible to conserve the uterus, for further fertility and pregnancy outcomes. In the developed world, most cases occur in women with a uterine scar [2–4]. In less and least developed countries, cephalopelvic disproportion causing obstructed labor is the major cause of uterine rupture [5–7]. The prevalence of uterine rupture is likely to increase in the developed world reflecting increasing rates of cesarean section, and it continues to contribute significantly to maternal mortality among women giving birth in the developing world.
    Sanfujinka no jissai. Practice of gynecology and obstetrics 11/1967; 16(10):951-4.
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