One C Section, Two, Three and Four

Five or more C sections increases risk of birth complications and preterm birth

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Having five or more children may not be a common occurrence, but if they were all born by C section, moms should take note. Their risk of birth complications are higher.

A recent study found women have a higher risk of early birth and complications after they have already had four cesarean sections.

"Discuss birth options with your OB/GYN."

Mandish Dhanjal, of the Department of Obstetrics and Gynecology at Imperial College Healthcare NHS Trust in the United Kingdom, and colleagues conducted the study.

They compared 94 women who had had multiple repeat cesarean sections with 175 women who had a lower number of C sections.

Multiple repeat cesarean sections occur when a woman has five or more C sections to deliver her baby.

The researchers found preemies were born more often to women with five or more C sections.

While only 5 percent of the women with fewer C sections had their babies before the 37th week of pregnancy, 24 percent of the women with multiple repeat C section had preemies.

Among the women with the multiple repeat C sections, 18 percent experienced major hemorrhaging during their delivery compared to only 0.6 percent in the group of women who had fewer C sections.

Overall, 17 percent of the women who were having their fifth or greater C section required a blood transfusion. Only 1 percent of the women with fewer C sections needed one.

There was also a relatively high percentage of women — 18 percent — in the multiple repeat C section group who had placenta previa or placenta accreta.

During placenta accreta, the placenta does not detach easily from the uterine wall, which can lead to hemorrhaging once it is surgically removed.

Placenta previa is a dangerous condition in which the placenta grows over the lowest part of the womb and blocks some or all of the cervical opening.

Although it is not common for women to have as many as five or more C sections, it is important for them to consider the risks if they have already had four C sections.

"Multiple repeat cesarean sections are an unusual occurrence and for most women the outcomes are very good," Dr. Dhanjal said in a release about the study. However, women should still be aware of the risks, he said.

"All cesarean section procedures carry risks, some that are life threatening," he said. "Larger studies are needed to look at this in more detail before firm recommendations are made about the maximum number of cesarean sections which should be performed."

The study was published October 31 in BJOG: An International Journal of Obstetrics and Gynecology. The research was funded by the Royal College of Obstetricians and Gynecologists/UK Obstetric Surveillance System annual award 2008 from the Edgar Research Fellowship Fund. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
October 29, 2012
Last Updated:
November 1, 2012