Skip to main content
SpringerLink
Log in

Anesthetic considerations for high order cesarean sections: a prospective cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

In a previous retrospective study we demonstrated that perioperative complications occurred in a minority of high order repeat cesarean sections (HOR-C/S). In this prospective study we compared the incidence of complications in patients who have had four or more cesarean sections to those that had three or less.

Methods

This was a prospective, observational cohort study of parturients undergoing C/S at a single tertiary care hospital over a 1 year period. We compared the incidence of conversion from regional to general anesthesia, duration of surgery and incidence of major blood loss in HOR-C/S to control.

Results

We studied a total of 831 parturients, 129 underwent HOR-C/S. The incidence of conversion from regional to general anesthesia was similar in both groups (RR = 0.97, 95 % CI 0.2, 4.3). The median duration of surgery was 40 min (range 10–145 min) in the HOR-C/S group and 30 min (range 10–150 min) in the control group (p < 0.001). The incidence of prolonged surgery was increased in the HOR-C/S group (RR = 3.6, 95 % CI 2.4, 5.4). The incidence of intraoperative blood transfusion was higher in the HOR-C/S group (RR = 3.4, 95 % CI 1.1, 10.2).

Conclusions

Patients who have HOR-C/S are more likely to have prolonged surgery and require blood transfusion than controls. However, in our population, this was not associated with an increased incidence of conversion from regional to general anesthesia. Provided causes of severe hemorrhage such as abnormal placentation have been ruled out, HOR-C/S is not an absolute contraindication to regional block.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Montgomery A, Hale TW et al (2006) ABM Protocol #15. Analgesia and anesthesia for the breastfeeding mother. Breastfeed Med 1:271–277

    Article  PubMed  Google Scholar 

  2. Rashid M, Rashid RS (2004) Higher order repeat caesarean sections: how safe are five or more? Brit J Obs Gyn 111:1090–1094

    Article  Google Scholar 

  3. Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH (2005) Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 193:1045–1049

    Article  PubMed  Google Scholar 

  4. Chang CC, Wang IT, Chen YH, Lin HC (2011) Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries. Am J Obstet Gynecol 205:462.e1–462.e7

    Article  Google Scholar 

  5. Ioscovich A, Mirochnitchenko E, Halpern S, Samueloff A, Grisaru-Granovsky S, Gozal Y, Einav S (2009) Perioperative anaesthetic management of high-order repeat caesarean section: audit of practice in a university-affiliated medical center. Int J Obstet Anesth 18:314–319

    Article  CAS  PubMed  Google Scholar 

  6. Clark EA, Silver RM (2011) Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 205(6 Suppl):S2–S10

    Article  PubMed  Google Scholar 

  7. Silver RM, Landon MB, Rouse DJ et al (2006) National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107:1226–1232

    Article  PubMed  Google Scholar 

  8. Pan PH, Bogard TD, Owen MD (2004) Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 13:227–233

    Article  CAS  PubMed  Google Scholar 

  9. Kinsella SM (2008) A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia 63:822–832

    Article  CAS  PubMed  Google Scholar 

  10. http://www.brixtonhealth.com/pepi4windows.html

  11. Parekh N, Husaini SW, Russell IF (2000) Caesarean section for placenta praevia: a retrospective study of anaesthetic management. Br J Anaesth 84:725–730

    Article  CAS  PubMed  Google Scholar 

  12. Ismail S, Huda A (2009) An observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth 18(4):352–355

    Article  CAS  PubMed  Google Scholar 

  13. Tevet A, Grisaru-Granovsky S, Samueloff A, Ioscovich A (2012) Peripartum use of cell salvage: a university practice audit and literature review. Arch Gynecol Obstet 285:281–284

    Article  PubMed  Google Scholar 

  14. Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T (2004) Multiple cesarean section morbidity. Int J Gynaecol Obstet 87:227–232

    Article  CAS  PubMed  Google Scholar 

  15. Selo-Ojeme DO, Bhattacharjee P, Izuwa-Njoku NF, Kadir RA (2005) Emergency peripartum hysterectomy in a tertiary London hospital. Arch Gynecol Obstet 271:154–159

    Article  PubMed  Google Scholar 

  16. Güngördük K, Yildirim G, Dugan N, Polat I, Sudolmus S, Ark C (2009) Peripartum hysterectomy in Turkey: a case-control study. J Obstet Gynaecol 29:722–728

    Article  PubMed  Google Scholar 

  17. Christopoulos P, Hassiakos D, Tsitoura A, Panoulis K, Papadias K, Vitoratos N (2011) Obstetric hysterectomy: a review of cases over 16 years. J Obstet Gynaecol 31:139–141

    Article  CAS  PubMed  Google Scholar 

  18. Chaillet N, Dumont A (2007) Evidence-based strategies for reducing cesarean section rates: a meta-analysis. Birth 34:53–64

    Article  PubMed  Google Scholar 

  19. Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL (2011) Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 118:29–38

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Gynecological and High Risk Obstetric Anaesthesia Unit, The Department of Anesthesiology, Perioperative Medicine and Pain Treatment of The Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel

    Alexander Ioscovich

  2. Department of Anesthesiology, Perioperative Medicine and Pain Treatment of The Shaare Zedek Medical Centre, Jerusalem, Israel

    Elena Mirochnitchenko

  3. Division of Obstetrical Anaesthesia, The Department of Anaesthesia, Sunnybrook Health Sciences Center University of Toronto, Toronto, Canada

    Alexander Ioscovich, Elena Mirochnitchenko, Stephen H. Halpern, Arnon Smueloff, Sorina Grisaru-Granovsky, Yaacov Gozal & Sharon Einav

  4. The Department of Obstetrics and Gynecology, The Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel

    Arnon Smueloff & Yaacov Gozal

  5. Department of Anesthesiology, Perioperative Medicine, and Pain Treatment of the Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel

    Alexander Ioscovich, Elena Mirochnitchenko, Stephen H. Halpern, Arnon Smueloff, Sorina Grisaru-Granovsky, Yaacov Gozal & Sharon Einav

  6. Surgical Intensive Care of the Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel

    Sharon Einav

Authors
  1. Alexander Ioscovich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Mirochnitchenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen H. Halpern
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arnon Smueloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sorina Grisaru-Granovsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yaacov Gozal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sharon Einav
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Ioscovich.

Additional information

A. Ioscovich and E. Mirochnitchenko are contributed equally to this paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ioscovich, A., Mirochnitchenko, E., Halpern, S.H. et al. Anesthetic considerations for high order cesarean sections: a prospective cohort study. Arch Gynecol Obstet 289, 533–540 (2014). https://doi.org/10.1007/s00404-013-3008-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-013-3008-4

Keywords

Search

Navigation