{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T16:20:37Z","timestamp":1790439637809,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,10,24]],"date-time":"2012-10-24T00:00:00Z","timestamp":1351036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:p><jats:bold>Objective\u2002<\/jats:bold> To estimate the incidence of multiple repeat caesarean section (MRCS) (five or more) in the UK and to describe the outcomes for women and their babies relative to women having fewer repeat caesarean sections.<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> A national population\u2010based prospective cohort study using the UK Obstetric Surveillance System (UKOSS).<\/jats:p><jats:p><jats:bold>Setting\u2002<\/jats:bold> All UK hospitals with consultant\u2010led maternity units.<\/jats:p><jats:p><jats:bold>Population\u2002<\/jats:bold> Ninety\u2010four women having their fifth or greater MRCS between January 2009 and December 2009, and 175 comparison women having their second to fourth caesarean section.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Prospective cohort and comparison identification through the UKOSS monthly mailing system.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> Incidence, maternal and neonatal complications. Relative risk, unadjusted (OR) and adjusted (aOR) odds ratio estimates.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> The estimated UK incidence of MRCS was 1.20 per 10\u2003000 maternities [95% confidence interval (CI), 0.97\u20131.47]. Women with MRCS had significantly more major obstetric haemorrhages (&gt;1500\u2003ml) (aOR, 18.6; 95% CI, 3.89\u201388.8), visceral damage (aOR, 17.6; 95% CI, 1.85\u2013167.1) and critical care admissions (aOR, 15.5; 95% CI, 3.16\u201376.0), than women with lower order repeat caesarean sections. These risks were greatest in the 18% of women with MRCS who also had placenta praevia or accreta. Neonates of mothers having MRCS were significantly more likely to be born prior to 37\u2003weeks of gestation (OR, 6.15; 95% CI, 2.56\u201315.78) and therefore had higher rates of complications and admissions.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> MRCS is associated with greater maternal and neonatal morbidity than fewer caesarean sections. The associated maternal morbidity is largely secondary to placenta praevia and accreta, whereas higher rates of preterm delivery are most likely a response to antepartum haemorrhage.<\/jats:p>","DOI":"10.1111\/1471-0528.12010","type":"journal-article","created":{"date-parts":[[2012,10,24]],"date-time":"2012-10-24T22:53:56Z","timestamp":1351119236000},"page":"85-91","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study"],"prefix":"10.1111","volume":"120","author":[{"given":"JR","family":"Cook","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Jarvis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MK","family":"Dhanjal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,10,24]]},"reference":[{"key":"e_1_2_12_2_2","volume-title":"Caesarean Deliveries in NHS Hospitals 2004","author":"Office for National Statistics","year":"2005"},{"key":"e_1_2_12_3_2","first-page":"CD006066","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"19","author":"Alfirevic Z","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_4_2","volume-title":"Caesarean Section: NICE Clinical Guideline 132","author":"National Institute of Clinical Excellence","year":"2011"},{"key":"e_1_2_12_5_2","volume-title":"Birth after previous caesarean birth. 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