What are the risks of multiple repeat caesarean sections?

Each repeat caesarean increases the risk of: placenta praevia and especially placenta accreta spectrum (morbidly adherent placenta) - a major cause of catastrophic haemorrhage.

Also: dense adhesions (making surgery harder and risking bladder/bowel injury), uterine scar rupture, haemorrhage and hysterectomy, and increased operative difficulty/time. These risks rise with the number of previous caesareans.

Clinical relevance. Knowing the cumulative risks of repeat caesareans (especially accreta and haemorrhage) informs counselling about family size and anticipating placental complications.

More Detail

Risks of multiple repeat caesarean sections

Risks accumulate with each repeat caesarean, especially placental complications.

Placental complications (the major concern)

• Placenta praevia - increased risk (scar affects implantation).
• Placenta accreta spectrum (accreta/increta/percreta - morbidly adherent placenta) - the risk rises sharply with the number of previous caesareans, especially with an anterior placenta praevia over the scar.
• These cause massive haemorrhage, often requiring hysterectomy and multidisciplinary planning.

Surgical complications

• Dense intra-abdominal/pelvic adhesions - making repeat surgery harder and increasing the risk of bladder and bowel injury.
• Uterine scar rupture.
• Increased operative time, blood loss, and need for transfusion/hysterectomy.

Implication

• The cumulative risk of serious morbidity increases with each caesarean - relevant to counselling women about family size and mode of delivery, and to anticipating accreta.