American Journal of Obstetrics and Gynecology, 2011
Abstract
Objective
The purpose of this study was to determine the impact of increasing numbers of cesarean deliveries on maternal morbidity. This study was performed for the 2010 National Institutes of Health Consensus Development Conference on Vaginal Birth After Cesarean: New Insights.
Study Design
We conducted a systematic review and metaanalysis of observational studies.
Results
Twenty-one studies (2,282,922 deliveries) were included. The rate of hysterectomy, blood transfusions, adhesions, and surgical injury all increased with increasing number of cesarean deliveries. The incidence of placenta previa increased from 10/1000 deliveries with 1 previous cesarean delivery to 28/1000 with ≥3 cesarean deliveries. Compared with women with previa and no previous cesarean delivery, women with previa and ≥3 cesarean deliveries had a statistically significant increased risk of accreta (3.3-4% vs 50-67%), hysterectomy (0.7-4% vs 50-67%), and composite maternal morbidity (15% vs 83%; odds ratio, 33.6; 95% confidence interval, 14.6-77.4).
Conclusion
Serious maternal morbidity progressively increased as the number of previous cesarean deliveries increased.
Topics
PMID 22071057 22071057 DOI 10.1016/j.ajog.2011.06.035 10.1016/j.ajog.2011.06.035 Marshall et al. 2011, Marshall 2011
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