Objective: To assess maternal and neonatal risk associated with high order cesarean sections, a case-control study was conducted at King Abdulaziz University Hospital from 2000-2009. Material and Methods: The outcome of 62 pregnancies of women undergoing cesarean section for the fifth time or more was compared with that of 210 women who underwent cesarean section for the first, second, third, or fourth time. Results: The main outcome measures were maternal operative and postoperative morbidity, neonatal prematurity and its complications, Apgar scores, and the need for intensive care. Women undergoing multiple (≥5) cesarean sections did not have significantly more intra-abdominal adhesions than women sectioned for the second, third, or fourth time. The postoperative course was not adversely affected by multiple cesarean sections. A high incidence of preterm cesarean deliveries was noted in the study group. This was due to non-elective repeat cesarean delivery rather than to poor timing of scheduled cesarean sections. Conclusion: High order repeat cesarean sections do not pose a serious threat to the fetus or increase the maternal morbidity in women without obstetric risk factors if standard care is provided.
