Maternal and Neonatal Outcomes Following Elective Versus Emergency Repeat Cesarean Section in Women with One Previous Cesarean Delivery: A Comparative Cohort Study

Abstract

Objective: To compare maternal and neonatal outcomes between elective and emergency repeat cesarean section in women with previous cesarean delivery.
Study Design: Retrospective cohort study.
Place and Duration of Study: The study was conducted in the obstetrics and gynecology unit of National Guards hospital Madinah Munawara, KSA from July 2025 to December 2025.
Materials and Methods: A total of 130 women with one previous cesarean section who underwent repeat cesarean delivery were included in the study. Among them, 65 underwent elective cesarean section and 65 chose trial of labour as their mode of delivery but later underwent emergency cesarean section due to complications arising during labour. Maternal outcomes assessed included uterine tears, postpartum hemorrhage, blood transfusion, bladder injury, puerperal wound infection, thrombosis, maternal death, and prolonged hospital stay. Neonatal outcomes included respiratory distress, aspiration of liquor, perinatal death, low Apgar score, and NICU admission. Demographic variables including maternal age, BMI, diabetes, parity, and fetal weight were also analyzed. To determine the odds of adverse outcomes between emergency versus elective caesarean groups, odds ratios with confidence interval were calculated for all variables. Chi square test was applied to assess the association of maternal and fetal outcomes with emergency cesarean.
Results: Odds ratio in Table II and III showed that patients in group I (emergency cesarean) had higher odds for adverse maternal and neonatal outcomes in the emergency caesarean group compared with the elective group except maternal death due to zero cases in the elective group. while Chi square test (Table IV) showed significant association of maternal outcomes like uterine tears p=.027, and puerperal wound infection p=.015 while
border line association of PPH p=.049, blood transfusion p=.049 and low Apgar score p=.05 with emergency cesarean group I.
Conclusion: These findings indicate that although emergency cesarean section may have a greater odd of adverse maternal and neonatal outcomes, only uterine injury, postpartum hemorrhage, need for blood transfusion, puerperal wound infection and low Apgar score related morbidity showed statistically significant association with emergency cesarean compared to elective cesarean.