Obstetric and perinatal outcome of women para > or = 5 including one lower segment cesarean section.

OBJECTIVE

To study the prevalence of antenatal, intrapartum and postnatal complications and their perinatal outcome in women who are delivering for the 6th time and have also had one cesarean section.

METHODS

The records of all women para > or = 5 with one previous cesarean section (n = 238) delivered at King Fahd Hospital of the University between the January 1 1994 and December 31 2000 were reviewed and compared with women who delivered at the hospital in the year 2000 (n = 2470). This data was analyzed for the peripartum and perinatal outcome.

RESULTS

The incidence of malpresentation was higher in the study group. The incidence of uterine rupture and uterine scar dehiscence was significantly higher in the study group, but there was no perinatal or maternal death associated with this and in all cases the uterus was preserved. More women managed to deliver vaginally after the cesarean section in the grandmultiparous women compared with the women in the control group (81.5% vs 63.0%) P < 0.00006, where the cesarean section rate was significantly higher (P < 0.02). There were no significant differences in the incidences of preterm labor, lethal malformations, stillbirths and neonatal deaths in the two groups of women. There was one case of cesarean hysterectomy in each group due to placenta accreta and atonic postpartum hemorrhage, and one maternal death in the control group.

CONCLUSION

Grandmultiparous women with one previous cesarean section have an increased risk of operative delivery, scar dehiscence, but there is no increase in perinatal or maternal mortality.