{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:14:01Z","timestamp":1792026841664,"version":"4.4.0"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to estimate the association between adverse maternal outcomes and the number of repeated cesarean deliveries (CDs) in a single obstetrical practice.<\/jats:p><jats:p>\n            Study Design\u2003Retrospective cohort study of all CDs between 2005 and 2020 in a single maternal fetal medicine practice. We used electronic records to get baseline characteristics and pregnancy\/surgical outcomes based on the number of prior CDs. We performed two subgroup analyses for women with and without placenta previa. Chi-square for trend and one-way analysis of variance (ANOVA) were used.<\/jats:p><jats:p>\n            Results\u2003A total of 3,582 women underwent CD and met inclusion criteria. Of these women, 1,852 (51.7%) underwent their first cesarean, 950 (26.5%) their second, 382 (10.7%) their third, 191 (5.3%) their fourth, 117 (3.3%) their fifth, and 84 (2.3%) their sixth or higher CDs. The incidence of adverse outcomes (placenta accreta, uterine window, uterine rupture, hysterectomy, blood transfusion, cystotomy, bowel injury, need for a ventilator postpartum, intensive care unit admission, wound complications, thrombosis, reoperation, and maternal death) increased with additional CDs. However, the absolute rates remained low. In women without a placenta previa, the likelihood of adverse outcome did not differ across groups. In women with a placenta previa, adverse outcomes increased with increasing CDs. However, the incidence of placenta previa did not increase with increasing CDs (&lt;5% in each group). The incidence of a uterine dehiscence increased significantly with additional CDs: first, 0.2%; second, 2.0%; third, 6.6%; fourth, 10.3%; fifth, 5.8%; and sixth or higher, 10.4% (p\u2009&lt;\u20090.001).<\/jats:p><jats:p>\n            Conclusion\u2003Maternal morbidity increases with CDs, but the absolute risks remain low. For women without placenta previa, increasing CDs is not associated with maternal morbidity. For women with placenta previa, risks are highest, but the incidence of placenta previa does not increase with successive CDs. The likelihood of uterine dehiscence increases significantly with increasing CDs which should be considered when deciding about timing of delivery in this population.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1736183","type":"journal-article","created":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T22:49:28Z","timestamp":1632869368000},"page":"1431-1436","source":"Crossref","is-referenced-by-count":2,"title":["Maternal Morbidity with Repeated Cesarean Deliveries"],"prefix":"10.1055","volume":"40","author":[{"given":"Rebecca","family":"Klahr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7328-3660","authenticated-orcid":false,"given":"Kevin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Markovic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Naert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Rebarber","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Maternal Fetal Medicine Associates, PLLC, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan S.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Maternal Fetal Medicine Associates, PLLC, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"issue":"359","key":"ref1","first-page":"1","article-title":"Recent trends in vaginal birth after cesarean delivery: United States, 2016-2018","author":"M JK Osterman","year":"2020","journal-title":"NCHS Data Brief"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"R M Silver","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"262.e1","DOI":"10.1016\/j.ajog.2011.06.035","article-title":"Impact of multiple cesarean deliveries on maternal morbidity: a systematic review","volume":"205","author":"N E Marshall","year":"2011","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1097\/AOG.0000000000000181","article-title":"Pregnancy outcomes in patients with prior uterine rupture or dehiscence","volume":"123","author":"N S Fox","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.ajog.2004.12.082","article-title":"Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option?","volume":"192","author":"G A Macones","year":"2005","journal-title":"Am J Obstet Gynecol"},{"issue":"191","key":"ref6","first-page":"1","article-title":"Vaginal birth after cesarean: new insights","author":"J M Guise","year":"2010","journal-title":"Evid Rep Technol Assess (Full Rep)"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1055\/s-0040-1717107","article-title":"Association between number of prior cesareans and early preterm delivery in women with abnormal placentation","volume":"38","author":"A Oben","year":"2021","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/01.AOG.0000206182.63788.80","article-title":"Previous cesarean delivery and risks of placenta previa and placental abruption","volume":"107","author":"D Getahun","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S0002-9378(97)70017-6","article-title":"The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis","volume":"177","author":"C V Ananth","year":"1997","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref10","first-page":"976","article-title":"The likelihood of placenta previa with greater number of cesarean deliveries and higher parity","volume":"99","author":"M Gilliam","year":"2002","journal-title":"Obstet Gynecol"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1055\/s-0038-1641587","article-title":"Optimal timing of delivery in women with higher order cesareans: a cohort study","volume":"35","author":"E S Miller","year":"2018","journal-title":"Am J Perinatol"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1002\/uog.12479","article-title":"Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis","volume":"42","author":"N Kok","year":"2013","journal-title":"Ultrasound Obstet Gynecol"}],"container-title":["American Journal of 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