Vaginal Birth After Cesarean: The Facts

3. Risks that derive from accumulating cesareans. Some complications arise from the build-up of scar-tissue in the pelvic cavity. Some are likely due to accumulating uterine scars leaving bare patches in the uterine lining, the layer in which the placenta implants. Still others may be due to post surgical infection injuring delicate tissues such as the cilia lining the Fallopian tubes that link ovaries to uterus.

Increased risk of injury to other organs during subsequent cesareans: Scar tissue makes successive cesareans more difficult technically to perform.

Increased risk of chronic pain and bowel problems.

Ectopic pregnancy: Embryo implants outside of the uterus: (Potentially life-threatening for mother, invariably fatal for the baby.) A study found no increase in ectopic pregnancy in women with one prior cesarean but half again the risk (3 percent versus 2 percent) in women with a history of more than one cesarean (18).

Placental abruption: Placenta detaches before the birth: (Potentially life-threatening for mother and baby.) Two to four times the risk compared with an unscarred uterus depending on whether the woman’s first birth was a cesarean, or she has more than one prior birth and at least one cesarean (18).

Placenta previa: Placenta overlays the cervix: (Potentially life-threatening for mother and baby.) More than four times the risk with one prior cesarean, seven times the risk with two to three, and forty-five times the risk with four (2).

Placenta accreta or percreta: Placenta grows into or through the muscular wall of the uterus: (Particularly dangerous for mother and baby.) Eleven times the risk with multiple prior cesareans compared with one prior cesarean -- nearly 1 per 100 versus 1 per 1,000 (2). In a study of 109 cases of placenta percreta, 40 percent of women required transfusion of more than ten units of blood, nearly all had hysterectomies, and ten babies and eight mothers died (28).

Both placenta accreta and placenta previa: Eight out of ten women with both had prior cesareans (34). The risk for the combination was 35 times higher for women with a prior cesarean compared to women with unscarred uteruses.

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