Understanding the Recurrence of Cesarean Sections: Common Causes and Outcomes

Author(s): Dr. Nigar Sultana, Dr. Fahmida Zabin, Dr. Kazi Farhana Begum, Dr. Kaniz Fatema, Dr. Mehera Parveen, Dr. Hasna Hena Pervin, Dr. Farah Noor, Dr. Ayesha Mehnaz

Background:

Cesarean sections (C-sections) are among the most common surgical procedures worldwide, with an increasing trend in both first-time and recurrent cesareans. Recurrent C-sections, in particular, pose significant risks for maternal and neonatal outcomes, yet many are performed due to the recurrence of initial cesarean indications or maternal request.

Methods:

This prospective observational study aimed to compare the causes and outcomes of recurrent versus first-time C-sections among 120 women at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Universal Medical College & Hospital Ltd. in Dhaka, Bangladesh, over a one-year period. Of the participants, 72 had recurrent C-sections and 48 had first-time C-sections.

Results:

The most common cause for recurrent C-sections was the recurrence of the initial cesarean indication (38.9%), while fetal distress was the leading cause of first-time C-sections (33.3%). Recurrent C-sections were associated with longer operative times (55.4 ± 12.3 minutes vs. 48.7 ± 10.5 minutes; p < 0.001) and greater blood loss (550 ± 150 mL vs. 470 ± 110 mL; p = 0.005). Uterine rupture occurred in 4.2% of recurrent cases, with no cases in first-time C-sections. Postpartum hemorrhage rates were similar (13.9% vs. 12.5%; p = 0.623). Neonatal outcomes, including NICU admissions (16.7% vs. 8.3%) and respiratory distress (12.5% vs. 10.4%), were slightly higher in recurrent C-sections but not statistically significant.

Conclusion:

This study highlights the need for careful decision-making in recurrent C-sections to minimize complications.