Multiple caesarean sections: outcomes and complications.

The outcome and complications of caesarean section were compared between 64 women who had had between three and eight previous sections (mean four) and 61 women sectioned for the first or second time. Gestational age was slightly less in the group with multiple operations. Of the women with three or more previous sections 27% had developed a fenestration in the transverse uterine scar; this was symptomless in half of them, and there was no associated severe ante- or intrapartum haemorrhage. Operation time was longer in women with multiple caesarean sections, and 13% required a caesarean hysterectomy. There were no other differences in the operative or postoperative courses between the two groups. In most women who have had multiple caesarean sections it is possible to wait for elective delivery until the fetus is mature. No absolute upper limit for the number of repeat caesarean sections can be given.