{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:14:20Z","timestamp":1792199660730,"version":"4.4.0"},"reference-count":58,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:p>\n                    Background: Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery, particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs.Methods: This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs, with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications, blood loss, and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth, neonatal ICU (NICU) admission, respiratory distress syndrome (RDS), and perinatal death.Results: Of the 6,316 women in the study, 2,608 (41.3%) had a primary CD. 30.3%, 17.5%, and 7.3% of the cohort had their second, third, and fourth CDs, respectively. Women undergoing the 5\n                    <jats:sup>th<\/jats:sup>\n                    CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1%, p\u00a0=\u00a00.015) and postpartum hemorrhage (7.5%, p\u00a0=\u00a00.010). 24% of babies in Group 5 were born preterm (p\u00a0&lt;\u00a00.001). They also had a 3.5 times higher risk of having a surgical complication (RR\u00a0=\u00a03.5, 95% CI 1.6-7.6, p\u00a0=\u00a00.002), a 1.8 times higher risk of developing postpartum hemorrhage (RR\u00a0=\u00a01.8, 95% CI 1.1-2.9, p\u00a0=\u00a00.014), a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR\u00a0=\u00a01.7, 95% CI 1.3-2.2, p\u00a0&lt;\u00a00.001), a higher risk of the baby getting admitted to NICU (RR\u00a0=\u00a01.3, 95% CI 1.0-1.6, p\u00a0=\u00a00.038), and developing RDS (RR\u00a0=\u00a01.5, 95% CI 1.2-2.0, p\u00a0=\u00a00.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9, 95% CI 2.1-4.0) and RDS (RR 3.5, 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p\u00a0&lt;\u00a00.001 for both).Conclusion: Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups\u2014consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2024.3","type":"journal-article","created":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T00:30:28Z","timestamp":1705192228000},"source":"Crossref","is-referenced-by-count":11,"title":["Maternal and neonatal outcomes associated with multiple repeat cesarean deliveries: A registry-based study from Qatar"],"prefix":"10.5339","volume":"2024","author":[{"given":"Shameena","family":"Ajmal","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. *Email: fminisha@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Farrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fathima","family":"Minisha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. *Email: fminisha@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawsan","family":"Al Obaidly","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. *Email: fminisha@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai","family":"AlQubaisi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najat","family":"Khenyab","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. *Email: fminisha@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najah","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. *Email: fminisha@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husam","family":"Salama","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Rouf Pallivalappil","sequence":"additional","affiliation":[{"name":"Department of Research, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"Al Dewik","sequence":"additional","affiliation":[{"name":"Department of Research, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilal","family":"Al Rifai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"issue":"(6):","key":"CIT0001","series-title":"BMJ Glob Health","first-page":"e005671","article-title":"Trends and projections of caesarean section rates: global and regional estimates","volume":"6","author":"Betran\n \nAP\n,","year":"2021"},{"issue":"(4):","key":"CIT0002","series-title":"Obstet Gynaecol","first-page":"265\u201372","article-title":"Complications of caesarean section","volume":"18","author":"Field\n \nA\n,","year":"2016;"},{"issue":"(1):","key":"CIT0003","series-title":"J Perinat Med","first-page":"5\u201316","article-title":"Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly","volume":"49","author":"Antoine\n \nC\n,","year":"2020"},{"issue":"(4):","key":"CIT0004","series-title":"Birth","first-page":"812\u2013822","article-title":"Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study","volume":"49","author":"Panda\n \nS\n,","year":"2022"},{"issue":"(1):","key":"CIT0005","series-title":"JRMS","first-page":"82\u20136","article-title":"Frequency Rate and Indications of Caesarean Sections at Prince Zaid Bin Al Hussein Hospital-Jordan","volume":"19","author":"Omar\n \nAAA\n,","year":"2012;"},{"issue":"(4):","key":"CIT0006","series-title":"Niger Med J","first-page":"263\u20135","article-title":"Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria","volume":"52","author":"Nwobodo\n \nEI\n,","year":"2011"},{"key":"CIT0007"},{"issue":"(2):","key":"CIT0008","series-title":"BMJ Open","first-page":"e023612","article-title":"Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar","volume":"9","author":"Bashir\n \nM\n,","year":"2019"},{"issue":"(9):","key":"CIT0009","series-title":"BMJ Open","first-page":"e029757","article-title":"Effect of prepregnancy maternal BMI on adverse pregnancy and neonatal outcomes: results from a retrospective cohort study of a multiethnic population in Qatar","volume":"9","author":"Shaukat\n \nS\n,","year":"2019"},{"issue":"(7\u20138):","key":"CIT0010","series-title":"J Reprod Med","first-page":"312\u20138","article-title":"Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome","volume":"58","author":"Gasim\n \nT\n,","year":"2013"},{"issue":"(1):","key":"CIT0011","series-title":"BJOG","first-page":"85-91","article-title":"Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study","volume":"120","author":"Cook\n \nJR\n,","year":"2013"},{"issue":"(1):","key":"CIT0012","series-title":"Am J Obstet Gynecol","first-page":"S355\u20136","article-title":"672: Neonatal outcomes after high-order cesarean delivery","volume":"214","author":"Friedman\n \nAM\n,","year":"2016"},{"issue":"(13):","key":"CIT0013","series-title":"Am J Perinatol","first-page":"1431\u20131436","article-title":"Maternal Morbidity with Repeated Cesarean Deliveries","volume":"40","author":"Klahr\n \nR\n,","year":"2023"},{"key":"CIT0014"},{"key":"CIT0015"},{"issue":"(3):","key":"CIT0016","series-title":"Qatar Med J","first-page":"69","article-title":"Impact of maternal nationality on caesarean section rate variation in a high-income country","volume":"2021","author":"Shittu\n \nS\n,","year":"2021"},{"issue":"(2):","key":"CIT0017","series-title":"Clin J Obstet Gynecol","first-page":"45\u201351","article-title":"Perinatal Morbidity & Mortality following repeat 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Gynecol","first-page":"e73\u2013e77","article-title":"Opinion No. 761: Cesarean Delivery on Maternal Request","volume":"133","year":"2019"},{"issue":"(6):","key":"CIT0022","series-title":"Obstet Gynecol","first-page":"1231\u20131238","article-title":"Neonatal outcomes after elective cesarean delivery","volume":"113","author":"Kamath\n \nBD\n,","year":"2009"},{"issue":"8:","key":"CIT0023","series-title":"Front Pediatr","first-page":"286","article-title":"Elective Cesarean Section on Term Pregnancies Has a High Risk for Neonatal Respiratory Morbidity in Developed Countries: A Systematic Review and Meta-Analysis","volume":"25;","author":"Tefera\n \nM\n,","year":"2020"},{"issue":"(2):","key":"CIT0024","series-title":"N Engl J Med","first-page":"111\u201320","article-title":"Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes","volume":"360","author":"Tita\n \nATN\n,","year":"2009"},{"issue":"(1):","key":"CIT0025","series-title":"Am J Obstet Gynecol","first-page":"110.e1\u2013110.e10","article-title":"Timing of cesarean delivery in women with \u2265\u00a02 previous cesarean deliveries","volume":"226","author":"Shinar\n \nS\n,","year":"2022"},{"issue":"(8):","key":"CIT0026","series-title":"BJOG An Int J Obstet Gynaecol","first-page":"e35\u2013e60","article-title":"Antenatal corticosteroids to reduce neonatal morbidity and mortality","volume":"129","author":"Stock\n \nSJ\n,","year":"2022"},{"issue":"(12):","key":"CIT0027","series-title":"Cochrane Database Syst Rev","first-page":"CD006614","article-title":"Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes","volume":"12","author":"Sotiriadis\n \nA\n,","year":"2021 Dec 22;"},{"key":"CIT0028","series-title":"BMJ","first-page":"i5044","article-title":"Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials","volume":"355:","author":"Saccone\n \nG\n,","year":"2016"},{"issue":"(10):","key":"CIT0029","series-title":"BJOG","first-page":"1090\u20134","article-title":"Higher order repeat caesarean sections: how safe are five or more?","volume":"111","author":"Rashid\n \nM\n,","year":"2004"},{"issue":"(6):","key":"CIT0001","series-title":"BMJ Glob Health","first-page":"e005671","article-title":"Trends and projections of caesarean section rates: global and regional estimates","volume":"6","author":"Betran\n \nAP\n,","year":"2021"},{"issue":"(4):","key":"CIT0002","series-title":"Obstet Gynaecol","first-page":"265\u201372","article-title":"Complications of caesarean section","volume":"18","author":"Field\n \nA\n,","year":"2016;"},{"issue":"(1):","key":"CIT0003","series-title":"J Perinat Med","first-page":"5\u201316","article-title":"Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly","volume":"49","author":"Antoine\n \nC\n,","year":"2020"},{"issue":"(4):","key":"CIT0004","series-title":"Birth","first-page":"812\u2013822","article-title":"Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study","volume":"49","author":"Panda\n \nS\n,","year":"2022"},{"issue":"(1):","key":"CIT0005","series-title":"JRMS","first-page":"82\u20136","article-title":"Frequency Rate and Indications of Caesarean Sections at Prince Zaid Bin Al Hussein Hospital-Jordan","volume":"19","author":"Omar\n \nAAA\n,","year":"2012;"},{"issue":"(4):","key":"CIT0006","series-title":"Niger Med J","first-page":"263\u20135","article-title":"Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria","volume":"52","author":"Nwobodo\n \nEI\n,","year":"2011"},{"key":"CIT0007"},{"issue":"(2):","key":"CIT0008","series-title":"BMJ Open","first-page":"e023612","article-title":"Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar","volume":"9","author":"Bashir\n \nM\n,","year":"2019"},{"issue":"(9):","key":"CIT0009","series-title":"BMJ Open","first-page":"e029757","article-title":"Effect of prepregnancy maternal BMI on adverse pregnancy and neonatal outcomes: results from a retrospective cohort study of a multiethnic population in Qatar","volume":"9","author":"Shaukat\n \nS\n,","year":"2019"},{"issue":"(7\u20138):","key":"CIT0010","series-title":"J Reprod Med","first-page":"312\u20138","article-title":"Multiple repeat cesarean sections: operative difficulties, maternal complications and outcome","volume":"58","author":"Gasim\n \nT\n,","year":"2013"},{"issue":"(1):","key":"CIT0011","series-title":"BJOG","first-page":"85-91","article-title":"Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study","volume":"120","author":"Cook\n \nJR\n,","year":"2013"},{"issue":"(1):","key":"CIT0012","series-title":"Am J Obstet Gynecol","first-page":"S355\u20136","article-title":"672: Neonatal outcomes after high-order cesarean delivery","volume":"214","author":"Friedman\n \nAM\n,","year":"2016"},{"issue":"(13):","key":"CIT0013","series-title":"Am J Perinatol","first-page":"1431\u20131436","article-title":"Maternal Morbidity with Repeated Cesarean Deliveries","volume":"40","author":"Klahr\n \nR\n,","year":"2023"},{"key":"CIT0014"},{"key":"CIT0015"},{"issue":"(3):","key":"CIT0016","series-title":"Qatar Med J","first-page":"69","article-title":"Impact of maternal nationality on caesarean section rate variation in a high-income country","volume":"2021","author":"Shittu\n \nS\n,","year":"2021"},{"issue":"(2):","key":"CIT0017","series-title":"Clin J Obstet Gynecol","first-page":"45\u201351","article-title":"Perinatal Morbidity & Mortality following repeat Cesarean section due to five or more previous Cesarean Section done in Tertiary centre in KSA","volume":"1","author":"Osman\n \nS\n,","year":"2018;"},{"issue":"21:","key":"CIT0018","series-title":"Med Sci Monit","first-page":"1447\u201353","article-title":"Effect of multiple repeat cesarean sections on maternal morbidity: data from southeast Turkey","author":"Kaplanoglu\n \nM\n,","year":"2015"},{"issue":"(4)","key":"CIT0019","series-title":"Pakistan J Med Heal Sci","article-title":"Maternal morbidity of higher order cesarean sections: An analytical study at sir ganga ram hospital Lahore","volume":"14","author":"Nisa\n \nMU\n,","year":"2020;"},{"issue":"(14):","key":"CIT0020","series-title":"J Matern Fetal Neonatal Med","first-page":"2395-2402","article-title":"Complications associated with higher order compared to lower order cesarean sections","volume":"33","author":"Abdelazim\n \nI\n,","year":"2020"},{"issue":"(1):","key":"CIT0021","series-title":"Obstet Gynecol","first-page":"e73\u2013e77","article-title":"Opinion No. 761: Cesarean Delivery on Maternal Request","volume":"133","year":"2019"},{"issue":"(6):","key":"CIT0022","series-title":"Obstet Gynecol","first-page":"1231\u20131238","article-title":"Neonatal outcomes after elective cesarean delivery","volume":"113","author":"Kamath\n \nBD\n,","year":"2009"},{"issue":"8:","key":"CIT0023","series-title":"Front Pediatr","first-page":"286","article-title":"Elective Cesarean Section on Term Pregnancies Has a High Risk for Neonatal Respiratory Morbidity in Developed Countries: A Systematic Review and Meta-Analysis","volume":"25;","author":"Tefera\n \nM\n,","year":"2020"},{"issue":"(2):","key":"CIT0024","series-title":"N Engl J Med","first-page":"111\u201320","article-title":"Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes","volume":"360","author":"Tita\n \nATN\n,","year":"2009"},{"issue":"(1):","key":"CIT0025","series-title":"Am J Obstet Gynecol","first-page":"110.e1\u2013110.e10","article-title":"Timing of cesarean delivery in women with \u2265\u00a02 previous cesarean deliveries","volume":"226","author":"Shinar\n \nS\n,","year":"2022"},{"issue":"(8):","key":"CIT0026","series-title":"BJOG An Int J Obstet Gynaecol","first-page":"e35\u2013e60","article-title":"Antenatal corticosteroids to reduce neonatal morbidity and mortality","volume":"129","author":"Stock\n \nSJ\n,","year":"2022"},{"issue":"(12):","key":"CIT0027","series-title":"Cochrane Database Syst Rev","first-page":"CD006614","article-title":"Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes","volume":"12","author":"Sotiriadis\n \nA\n,","year":"2021 Dec 22;"},{"key":"CIT0028","series-title":"BMJ","first-page":"i5044","article-title":"Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials","volume":"355:","author":"Saccone\n 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