Maternal and fetal morbidity and mortality following multiplecaesarean sections in Northern Jordan

Background. Increasing rates of both primary and repeated caesarean birth (CS) are an issue of international concern as theycan impact negatively on maternal and fetal morbidity and mortality. Increasing rates of both primary and repeated CS birthare an issue of international concern as they can impact negatively on maternal and fetal morbidity and mortality.Aim. The aim was to explore morbidity and mortality relating to repeat CS in JordanMethod. A retrospective cohort study was conducted in two large public hospitals, with data collected on repeat caesareanbirth outcomes for mothers who gave birth in the North of Jordan from June 2005 to June 2010. A specifically designedabstraction form was used to collect demographics social data and maternal and infant intranatal and postnatal outcomes.The instrument was subjected to several reviews carried out by the investigators and a pilot study was conducted to ensurespecificity and clarity. All women who had multiple repeated CS were divided into two groups, women who had three CS andwomen who had four CS and more, in order to compare the incidence of maternal and neonatal morbidity and mortality rates.Ethical approval was granted from the Human Subject Committee at Jordan University of Science and Technology. This studywas funded by Jordan University of Science and Technology.Results. The total sample consisted of 265 women; the majority had three previous CS (n=175, 66%), while 66 (25%) hadfour CS, 22 (8.3%) had five CS, one (0.4%) had six CS, and one (0.4%) had seven CS. A total of 42 women (15.8%) hadadhesions, 28 (10.6%) had placenta praevia, 23 (8.7%) needed blood transfusion, 18 women (6.8%) had a hysterectomy, 10women (3.8%) suffered uterine rupture, two women (0.8%) had placental abruption, two women (0.8%) had bladder injury,and two women (0.8%) developed disseminated intravascular coagulopathy (DIC). Compared with group of women withthree previous CS, the group of women with four CS and more had a significantly higher mean age, lower mean for gestational age, increased need for blood transfusion and were more likely to experience placenta praevia.Conclusion and implications. Multiple repeated CS pose potentially serious risks for maternal and neonatal health, whichincrease with the rising number of repeated CS. Therefore, women should be fully informed about the serious risks of multiple repeated CS and should be offered proper counselling by senior obstetrician and midwives for vaginal birth after CS,.