Perinatal outcomes of multiple cesarean sections

Introduction. The literature suggests that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections. Materials and methods. A retrospective observational case-control study was carried out. The study included 352 pregnant women with a singleton pregnancy and at least one previous cesarean section: 177 pregnant women with two or more previous cesarean sections (experimental group) and 175 with a primary cesarean section (control group). Excel tables were used to organize the data. For comparing categorical variables in groups, the χ² test was used. A p < 0.05 was considered statistically significant. Results. Termination of the pregnancy by cesarean section at 39 + 0 – 39 + 6 weeks of gestation (56.5% and 27.4%, respectively; p < 0.001) was statistically significantly more frequent in the experimental group. Analysis of deliveries revealed that emergency cesarean sections in pregnancy (18.9% and 9.0%, respectively; p < 0.01) and emergency cesarean sections during labor (60.6% and 30.5%, respectively; p < 0.001) were performed statistically significantly more frequently in the control group. Planned cesarean sections during pregnancy (60.5% and 20.6%, respectively; p < 0.001) were performed statistically significantly more frequently in the experimental group. The rate of full-term neonates was statistically significantly higher in women from the experimental group (96.6% and 83.4%, respectively; p < 0.001), and the rate of post-term neonates was statistically significantly higher in women from the control group (12.0%; p < 0.001). The Apgar score values 1 minute after birth equal to 8–10 points (130 – 84.4% and 10 – 47.6%, respectively; p < 0.001) were statistically significantly more frequent in pregnant women without acute fetal distress during labor, and the Apgar score values 1 minute after birth equal to 1–7 points (11 – 52.4% and 24 – 15.6%, respectively; p < 0.001) were statistically significantly more frequent in pregnant women with acute fetal distress during labor. Similar results were found in the Apgar score at 5 minutes after birth. Conclusions. In our research, it was demonstrated that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections.