Repeat Caesarean: More Risk

Women who have uterine caesarean scar have slightly increased long-term risks. These risks, which increase further with each additional caesarean delivery, include:

- Breaking open of incision scar during a later pregnancy or labour (uterine rupture, or tearing open of the uterus into the abdominal cavity), a serious condition that may result in hysterectomy, urologic injury or a need for blood transfusion for the mother, and neurological damage in the infant. 90% of uterine ruptures happen at the site of a scar from a previous C-section.

- Placenta previa (the growth of the placenta low in the uterus, blocking the cervix). Compared with women with no uterine scar, women have more than 4 times the risk of placenta previa with 1 prior caesarean, 7 times the risk with 2-3 prior caesareans, and 45 times the risk with 4 or more prior caesareans. Placenta previa more than doubles the chance of the baby dying and increases the rate of pre-term birth more than 6-fold.

- Placenta accreta, placenta increta, placenta percreta (least to most severe), the growth of the placenta deeper into the uterine wall than normal, which can lead to severe bleeding after childbirth, sometimes requiring a hysterectomy.

- The odd placenta accreta (placenta grows into or even through the uterus) jump from 1 in 1,000 with 1 prior caesarean to in 100 with more than 1 prior caesarean. Nearly all women with this complication will require a hysterectomy, nearly half will have a massive haemorrhage, and as many as 1 in 11 babies and 1 in 14 mothers will die. The incidence of placenta accrete has increased 10-fold in the last 50 years.

- Placental abruption. Compared with women with prior births and no previous caesareans, women with 1 prior caesarean or more have as much as 3 times the risk of placental abruption (early separation of a normal placenta from the wall of uterus). With placental abruption, 6 in every 100 babies will die, and 3 in 10 will be born too early.

Old scar tissue also increases the likelihood of surgical injury

One more woman in every 100 with a history of more than one caesarean will have an ectopic pregnancy (embryo implants outside the womb). Haemorrhage associated with ectopic pregnancy is one of the leading causes of maternal death in the US.

Women having elective repeat caesarean are more likely to experience haemorrhage requiring transfusion, blood clots, and infection.Postpartum recovery after repeat caesarean section is even more difficult when there is another child or children to care for.