Catastrophic complications of previous cesarean section

To determine the risk of catastrophic complications (including death) among pregnant women who have undergone a previous cesarean section, the medical records of all deliveries (10,835) at one hospital in a three-year period were reviewed. Seven hundred and eleven deliveries (6.6 percent) involved women with a previous cesarean section. Four hundred twenty-four women in this group attempted vaginal delivery, of whom 312 succeeded. Catastrophic complications included: maternal or fetal death; hemorrhage that required transfusion of five or more units of blood; hysterectomy (removal of the uterus); ligation (tying) of a major artery; or uterine rupture. By these criteria, 17 women with a previous cesarean section (eight had more than one) suffered catastrophic complications. These included two maternal and three fetal deaths. Eleven women had serious hemorrhage, eight of whom underwent hysterectomy. Nine had uterine rupture, and eight had placenta previa (attachment of the placenta near the opening of the uterus, associated with bleeding during delivery) or other abnormal conditions of the placenta. The overall rate of very serious complications of pregnancy after cesarean section was 1 patient out of 42, with a risk of maternal or fetal death in 1 out of 143 such pregnancies. These results indicate much higher rates than have been reported in other studies, and may partly be the result of the population studied (primarily black and Hispanic, and poor). The criteria for inducing labor in these women were the same criteria used for women without a prior cesarean, another factor that might have led to the high rate of uterine rupture. The overall frequency of catastrophic complications in this group of women with previous cesarean sections was 2.4 percent. Awareness of this possibility should affect decision-making when a patient's first cesarean section is contemplated. (Consumer Summary produced by Reliance Medical Information, Inc.)