Implications of multiple cesarean deliveries

Though the rate of cesarean delivery in the USA decreased in the1980s, it once again increased substantially over the last 20 years and accounts for about one third of all deliveries. Reasons for this trend are numerous and include a decrease in the rate of trial of labor after cesarean (TOLAC) delivery and an increase in primary cesareans, mostly due to labor abnormalities or abnormal fetal heart rate tracings. On balance, cesareans are relatively safe, contributing to our collective comfort with increasing numbers of procedures. However, there is considerable ‘downstream’ morbidity associated with cesareans, especially in women who undergo multiple procedures. This review will address the short-term and long-term complications associated with multiple cesarean sections and will briefly identify strategies to reduce the rate of cesarean delivery.