To assess the maternal and neonatal risk associated with high order cesarean sections, a
prospective study was carried out in Zawia hospital, maternity wards. The patient was interviewed in
the labor word and performed case sheet filled with specific data. The outcome of 458 cases, 218
women undergoing cesarean section for the third time or more was compared with 240 women
sectioned for the second time (P1c/s), the outcome measures were antenatal complication, maternal
operative and postoperative morbidity and neonatal prematurity, Apgar scores and the need for
intensive care. The antenatal complication is more in group of ≥ P2c/s, placenta previa 9 (3.7%)
versus 3 (1.3%) and abruption 8 (3.3%) versus 1 (0.4%). Intraoperative complications found in
17.7% of the cases, 14.2% of the patients with P1c/s comparing with 20.8% among the cases with ≥
2 Pc. Intra-peritoneal adhesions were more in women with ≥ P2c/s (10.8%) when compared with the
women with the history of P1c/s (8.7%). The need for blood transfusion was 5.0% of women with
history of ≥ P2c/s compared with 4.1% for women with history of one previous section. The mean
duration of operation for patients with P1c/s = 41.5 min and with P2 or more c/s = 47.8 min.
Neonatal morbidity rate was 20.9%. There were an increased number of preterm babies in study
group of ≥ 2 Pc/s. It is concluded that high order repeat cesarean section carry risk of intraoperative
and post operative complication in particularly, placenta previa and acreta and risk of blood
transfusion and also neonatal morbidity is increased.