Long-term maternal morbidity associated with repeat cesarean delivery

Am J Obstet Gynecol. 2011 Dec;205(6 Suppl):S2-10. doi: 10.1016/j.ajog.2011.09.028. Epub 2011 Oct 6.


Concern regarding the association between cesarean delivery and long-term maternal morbidity is growing as the rate of cesarean delivery continues to increase. Observational evidence suggests that the risk of morbidity increases with increasing number of cesarean deliveries. The dominant maternal risk in subsequent pregnancies is placenta accreta spectrum disorder and its associated complications. A history of multiple cesarean deliveries is the major risk factor for this condition. Pregnancies following cesarean delivery also have increased risk for other types of abnormal placentation, reduced fetal growth, preterm birth, and possibly stillbirth. Chronic maternal morbidities associated with cesarean delivery include pelvic pain and adhesions. Adverse reproductive effects may include decreased fertility and increased risk of spontaneous abortion and ectopic pregnancy. Clinicians and patients need to be aware of the long-term risks associated with cesarean delivery so that they can be considered when determining the method of delivery for first and subsequent births.

MeSH terms

  • Abortion, Spontaneous
  • Cesarean Section, Repeat / adverse effects*
  • Chronic Pain
  • Female
  • Humans
  • Hysterectomy / statistics & numerical data
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Infertility, Female / etiology
  • Morbidity
  • Placenta Accreta / epidemiology
  • Placenta Accreta / etiology
  • Placenta Accreta / pathology
  • Placenta Previa / epidemiology
  • Placentation
  • Postoperative Complications
  • Pregnancy
  • Pregnancy Complications / etiology*
  • Pregnancy, Ectopic
  • Premature Birth / epidemiology
  • Risk Factors
  • Stillbirth / epidemiology
  • Tissue Adhesions / etiology
  • Urinary Bladder / injuries