Evidence-Based Answers

Evidence Central™ is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research.


Evidence Central for Mobile Devices

Evidence Central iOS iPhone iPad Android

Evidence Central from Unbound Medicine, available for iOS® and Android™, is optimized for each platform and features superior navigation, so answers are easy to find at the bedside or anywhere they’re needed. Learn More

Word of the Day

Risk of serious maternal morbidity with multiple cesarean deliveries

Clinical Question:
Are multiple cesarean deliveries associated with an increased risk of serious maternal morbidity?

Bottom Line:
Serious maternal morbidity -- including hysterectomy, placenta accreta, and placenta previa -- increases with the number of cesarean deliveries (CDs). These risks should be considered in the decision to attempt trial of labor after a CD. (LOE = 2a)

Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011;205:262.e1-e8.

Study Design:
Meta-analysis (other)


Various (meta-analysis)

This systematic review and meta-analysis of observational studies was undertaken to determine the risk of serious maternal morbidity related to increasing numbers of CDs. The authors included 21 studies published from 1980 to 2009 from developed countries with 2,282,922 deliveries. They excluded studies of women without prior CD; studies of fewer than 10 study participants; studies of breech delivery; and those with exclusive focus on preterm delivery, low birth weight or multiple births. Study quality was methodically rated by 2 investigators and studies rated as poor quality were also excluded. Hysterectomy (7 studies) increased with increasing number of CDs. The odds ratio for hysterectomy rose with the number of CDs reaching an absolute risk of approximately 9% with 5 or more CDs (odds ratio = 15; 95% CI, 7-34). The absolute risk of placenta previa with any number of CDs was 1.2% (0.8-1.5) and increased from 1.0% with one prior CD to 2.8% with 3 or more. The incidence of placenta accreta increased with the number of CDs up to an approximately 7% absolute risk with 5 or more CDs. There was no observed increase in the risk of perioperative infection. The abstract cited increased risks of transfusion and composite maternal morbidity, but details were not provided in this publication.


Site Licenses

Site license

Site Licenses are available for schools, universities, hospitals, government agencies, and companies. For more information, contact us.