Abstract
Objective: To observe the effects of repeat cesarean sections on mother and fetal outcomes.
Methodology: This observational study was conducted in the Obstetrics and Gynecology Department, District Headquarter Hospital, Rawalpindi, Pakistan from Feb 2019 to Jan 2020. The study included recurrent cesarean patients, divided into three groups; Group I women (n=300) who had 2 births by C-section, Group II (n=185) included women who had 3 births by C-section, and Group III (n=45) included women who had four or more C-section. Case records were analyzed for demographic and clinical features such as age, duration of surgery, parity, and hospital stay prenatal complications and estimated blood loss (EBL) during surgery. Intraoperative complications were observed in terms of severe adhesions, scar separation, placenta praevia, morbid adherent placenta, surrounding intestinal damage, anesthetic complications, the need for blood transfusions and fetal outcomes.
Results: A significant increase was observed in women with more than two cesarean births in adhesions, placenta adhesion, placenta praevia and obstetric hysterectomy requirements. We could not find a significant increase in surgery time, injuries to surrounding structures, need for blood transfusions, and anesthesia complications between the three groups.
Conclusion: Women with recurrent cesarean sections are at risk of developing intraoperative complications that may increase the risk of fetal and maternal morbidity, but their greater number does not constitute an additional risk.

Key words: Cesarean section, cesarean section, repeat, morbidity, fetomaternal.