The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates.

OBJECTIVE: The cesarean delivery rate has increased worldwide. The aim of our study was to assess the events associated with the second cesarean deliveries in our institution.

SUBJECTS AND METHODS: All the cesarean deliveries at Maternity Hospital, Kuwait, from January 1 to December 31, 2013, were identified. A comparative study was undertaken on patients having their first and second cesarean deliveries. The social and clinical characteristics of these patients were extracted from our records and the antenatal, intra-partum, and postpartum course of the pregnancies and their outcomes documented.

RESULTS: During the study period, 10,586 deliveries were recorded, including 3,676 cesarean deliveries, a cesarean delivery rate of 34.7%. 840 of these patients were undergoing their first cesarean delivery (group A), and 607 patients were undergoing their second (group B); 484 patients from group A and 341 patients from group B with complete records were analyzed. Mean age (30.89 ± 4.93 vs 29.94 ± 5.56 years, p = 0.008), parity (1.49 ± 1.22 vs 0.98 ± 1.60, p < 0.0001), gestational age at delivery (38.12 ± 2.61 vs 37.66 ± 3.11 weeks, p = 0.02), and fetal birth weight (3,211.60 ± 691.51 vs 2,829.73 ± 863.26 grams, p < 0.001) were significantly higher in group B than in group A. 53.2% of the patients in group B requested repeat cesarean delivery, their second cesarean. The rate of maternal morbidity was low.

CONCLUSIONS: The incidence of repeat cesarean delivery in group B is high, and its reduction should contribute to a lowering of the overall cesarean delivery rate.