Third caesarean delivery

Doing a cesarean delivery for the third time often involves longer surgery times and more abundant losses, but otherwise, if the placenta is not previa or accreta and the previous deliveries have not given complications, it will be similar to a cesarean like the others.

When two previous caesareans have already taken place, often the third is considered inevitable, even if the guidelines of the Higher Institute of Health do not yet advise against the possibility of attempting a trial labor in this case.


But what are the differences compared to the other parts? It mainly depends on the course of the two previous operations, on the position of the placenta or on the presence of any anomalies.


First two caesareans without complications? No problem even the third

"If the previous caesareans were performed according to standard techniques and there were no complications, even the third surgery has all the conditions to go in the best possible way and have recovery times identical to the others," says Ferdinando, delivery room manager. of the Gynecology and Obstetrics Unit of the San Raffaele Hospital in our city.


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The chances of placenta previa and accreta increase

However, there is an important factor to consider and that is the risk of abnormalities in the formation and position of the placenta. "As the years go by and the number of pregnancies increases, the likelihood of the placenta implanting in the lower part of the uterus is higher, that is, that it is previa ", he explains." In this case, the risk that the placenta implants itself more deeply into the wall of the uterus also increases. " placenta accreta, which may require bringing the delivery date earlier. The duration of the surgery will be longer and the risk of serious complications, such as postpartum bleeding, will also slightly increase.

The surgery lasts longer than the previous ones: about 60 minutes

Even regardless of the position of the placenta, a repeated cesarean involves a lengthening of the time of the operation, since it is necessary to unstick the various surgical plans precisely before reaching the abdominal cavity: this means that if the first cesarean lasted an average of 40- 50 minutes, in the following you can get to 60-80 minutes.

Times that could be further lengthened if there are persistent adhesions, the removal of which requires more effort. Once 'arrived at destination', however, the times of incision of the uterus, extraction of the child and suturing are identical to the other parts.


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Blood loss can be more profuse

After three pregnancies ending in a cesarean, the uterus may have less contractile capacity and therefore postpartum bleeding is more likely. To avoid them, they are administered in the hours following the surgery oxytocin drip, which stimulate the uterus to contract, but as a precaution, the availability of blood is always requested for possible transfusions.

Rupture of the uterus? A marginal risk

Is there a risk of rupture of the uterus to subsequent deliveries after a caesarean section? "The risk of rupture of the uterus, or rather of laceration in correspondence with the previous scar, is a rather rare occurrence which concerns in particular the so-called trial travails, that is, when you try to do a vaginal birth after a cesarean "replies the gynecologist. So it is not the number of caesareans per se that carries this risk, but the fact of attempting the so-called VBAC, vaginal delivery after cesarean.


According to the Higher Institute of Health guidelines on caesarean section, VBAC is possible if there have been up to three caesarean sections previously. After the third one, the intervention is made directly.


The third caesarean must be scheduled

As with any caesarean, the ideal would be to have an elective surgery, that is, the date must be set, since an urgent caesarean always involves more risks. At the same time, we try not to anticipate the times too much because a premature birth could involve more risks for the newborn.

Spinal anesthesia can also be done with a third caesarean

Even if it is the third caesarean section, spinal anesthesia can be done. "General anesthesia is used only if it is an emergency cesarean and there are no tests available or if there are specific maternal indications, such as neurological or coagulation problems or a clear risk of bleeding," he says.

The hospital must be equipped for the risks of the third caesarean

The choice of hospital depends on the condition of the woman and on the characteristics of the hospital itself: if there are no complicating elements, such as diabetes or hypertension, if the placenta is in a normal position, if the hospital can have blood bags in good time short, the woman can give birth wherever she prefers. If, on the other hand, there are risk factors, it is better to contact a structure with a greater surgical specialization.

Updated on 20.07.2022

  • third caesarean
  • risks of a third caesarean
  • Caesarean section
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