The risk of major complications for the mother increases significantly when a woman undergoes several cesarean deliveries, according to researchers based in Israel.

“We believe that a decrease in multiple cesareans is especially important for women who desire many children,” Dr. Victoria Nisenblat told Reuters Health.

“This is possible,” she added, “by doing the best we can to reduce the number of first cesareans and perhaps even more important, increasing the percentage of vaginal births after cesareans in such populations.”

Nisenblat from Bnai-Zion Medical Center, Haifa, and colleagues evaluated the maternal complications associated with three or more cesarean deliveries compared with a second planned cesarean delivery by examining medical records of women who underwent repeat cesarean deliveries at their hospital.

Surgical difficulties, such as excessive blood loss, prolonged or difficult delivery, and dense adhesions were significantly more likely for the 277 women in the multiple-cesarean group than the 491 women in the second-cesarean group, the team reports in the medical journal Obstetrics & Gynecology.

The proportion of women having any major complication was significantly higher in the multiple-cesarean group (8.7 percent) than in the second-cesarean group (4.3 percent), the researchers note. In fact, the major complication rate increased from 7.5 percent with a third c-section to 12.5 percent with a fourth or more cesarean.

“When, after the first cesarean, the route of delivery is discussed with the patient, the doctor should take into consideration the family planning of this specific woman,” Nisenblat recommended.

“In the case of additional pregnancies planned, a vaginal birth after cesarean trial should be proposed,” she advised.

SOURCE: Obstetrics & Gynecology, July 2006.