Saadia, Gynecol Obstet 2013, 3:4 DOI: 10.4172/2161-0932.1000168 Research Article Open Access Volume 3 • Issue 4 • 1000168 Gynecol Obstet ISSN: 2161-0932 Gynecology, an open access journal Are Higher Order Caesarean Sections More Risky Compared to Lower Order Caesarean Sections? Zaheera Saadia* Obstetrics and Gynaecology, College of Medicine, Qassim University, Saudi Arabia Abstract Background: Saudi Arabian culture encourages large families, and therefore, it’s not uncommon to see women undergo several Caesarean Sections (CS). There is disagreement in the literature regarding the actual risks mothers face with higher order CSs. Aim: This study aims to explore whether more frequent higher order CSs result in more complications. Materials and methods: This study was a retrospective cohort study conducted at the Mother and Child Hospital in Burayda, Al Qassim, Saudi Arabia, between 31 st January and 31 st March 2012. Group 1 had undergone three or fewer CSs, and Group 2 had undergone more than three CSs. Comparisons between the mean values of the quantitative variables were calculated using the Student t test for quantitative data, and a chi-square for qualitative data. The test of signifcance was set at 0.05. Results: The CS rate for this time period was 28.6%. In all, 193 (56.3%) women were in Group 1, and 150 women (43.7%) were in Group 2. Sixty-nine women (46%) had four previous CSs; 58 (38.7%) had fve; 20 (13.3%) had six; and three women (2%) had seven previous CSs. The presence of complications, such as intra operative adhesions, adherent placenta, placenta previa, postpartum haemorrhage (PPH), wound infection, urinary tract infection and deep vein thrombosis, were higher in Group 2 (P<0.05). Conclusions: Higher order CSs are associated with higher complication rates. The precise scale of the trend of performing higher order CSs needs to be studied, and appropriate strategies at the national level should be implemented to encourage family planning. *Corresponding author: Zaheera Saadia, Assisstant Professor, Obstetrics and Gynaecology, College of Medicine, Qassim University, Alrajhi building 4, Apartment 108, King Khalid Road, Buraidah, Al-Qassim, Saudi Arabia, Tel: 00966-558690574; E-mail: zaheerasaadia@hotmail.com Received August 19, 2013; Accepted September 06, 2013; Published September 10, 2013 Citation: Saadia Z (2013) Are Higher Order Caesarean Sections More Risky Compared to Lower Order Caesarean Sections? Gynecol Obstet 3: 168. doi:10.4172/2161-0932.1000168 Copyright: © 2013 Saadia Z. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Caesarean section; Higher order; Risks; Saudi Arabia Introduction Te number of Caesarean Sections (CSs) has continued to increase worldwide in the last three decades [1-3]. Saudi Arabian culture, like that of most countries in the region, encourages having a large family, and therefore, it is not uncommon for Saudi women to undergo six or seven CS procedures [4]. Within the literature, there is disagreement regarding the actual risks women face with multiple CSs. Some studies report no increased risk whatsoever, and consequently, women are encouraged to pursue more pregnancies [5,6]. CSs, then, are becoming increasingly acceptable [7]. However, in light of the conficting studies and the rapid increase in performed CSs, especially in Saudi Arabia, this study was designed to compare the short-term complications and outcomes of CSs in women who have had more than three higher order CSs with women who have had three or fewer lower order CSs. Materials and Methods Tis was a retrospective cohort study that included all women admitted for CSs at the Mother and Child Hospital (MCH) in Buraydah, Saudi Arabia, from January 31 st to March 31 st , 2012. MCH is a major medical facility in the region with annual delivery rates of almost 10,000 newborns. All women who had undergone three or fewer CSs were included in Group 1 (control group), and those who were undergoing their fourth (or more) CS were included in Group 2 (case group). All of the CS’s were lower segment caesarean sections conducted by consultants or senior registrars. Te data collected included maternal age, parity, placental location on the ultrasound, gestation at delivery, duration of surgery, presence of adhesions (of any degree; and was categorised as “0” if no adhesions were found and “1” if adhesions were present), intraoperative and postoperative complications, and the number of postoperative days spent in the hospital. Chest infections (individuals with cough, sputum and fever), urinary tract infections (UTI) (burning micturation, frequency, urgency and positive culture with bacterial colony count of 10 3 /ml, Pyrexia of Unknown Origin (PUO) (fever above 38.3°C during hospital stay without attributable cause), and wound infection (redness, swelling, puss-like discharge or indurations of wound) were also observed. Scar dehiscence was defned as the presence of a window in part of the uterine scar with intact membranes. All data were kept anonymous, and approval from a local ethical committee was obtained prior to collection. Statistical study Te data were subsequently coded, tabulated and entered into a database on a laptop computer. Statistical analyses were then carried out using the SPSS statistical sofware (version 19) for Windows 7. Numbers and percentages were calculated for qualitative variables, and the mean and standard deviation were calculated for quantitative data. Comparisons between the mean values of the quantitative variables G y n e c o l o g y & O b s t e t r i c s ISSN: 2161-0932 Gynecology & Obstetrics