Maternal and neonatal adverse outcome at repeat cesarean delivery versus repeat vaginal delivery.

OBJECTIVE To determine selected maternal and neonatal adverse outcomes at repeat cesarean delivery compared with repeat vaginal delivery. STUDY DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Lyari General Hospital, Karachi, from January 2005 to December 2008. METHODOLOGY Healthy pregnant women at 28-42 weeks of second singleton pregnancy were selected for study. Those with previous cesarean birth was labelled the exposed group and those with previous vaginal birth were considered the control group. Maternal and neonatal morbidity's attributable to the previous cesarean section was estimated. Potential confounders like persistent medical disorders, previous adverse outcome and trial of scar cases was excluded. Results were presented in frequency and percentage. Effects of outcomes were calculated as odds ratio with 95% confidence interval. SPSS-16 was used for statistical data analysis. RESULTS A total of 195 mothers at repeat cesarean delivery were compared with 1486 mothers at repeat vaginal delivery. Mothers with previous cesarean birth were at high risk of peripartum hysterectomy and placenta accrete followed by placenta praevia [OR 7.6 (95% CI=0.48-122.8), 7.6 (0.48-122.8) and 2.5 (0.68-9.6) respectively]. Very preterm birth [OR=3.86, 95% CI 1.15-12.97)] was the most significant neonatal adverse outcome. CONCLUSION Cesarean section in first pregnancy conferred an additional risk in the second pregnancy even after exclusion of known complications of trial of scar. These should be part of overall clinical assessment at the time of first cesarean section.