Abstract
<jats:p>The incidence of primary and repeat cesarean sections (CS) is increasing worldwide. Globally, the incidence of CS has increased steadily from 6.7% in 1990 to 19.1% in 2014. The frequency of CS varies greatly across countries, and rates >50% for primary CS and >88 % for repeated CS. Consequently, there is a significant increase in higher-order cesarean sections with the association of severe complications. According to the statistical data of the Public Medical-Sanitary Institution Municipal Clinical Hospital „Gheorghe Paladi”, the number of total births decreased from 8330 in 2010 to 6685 in 2020. However, CS rates are increasing: from 14.3% in 2010 to 19.4% in 2020 for primary CSs and from 25.3% to 39.9%, respectively, for repeated CSs. The risk of rare but potentially serious maternal complications, such as visceral injury, hemorrhage, abnormal placentation, hysterectomy, or severe adhesions, increases significantly with the number of repeated CSs. About 9% of women undergoing multiple CSs experience major complications and about 1% require hysterectomy, most commonly as a result of abnormal placentation. There is no absolutely clear threshold for a safe number of CSs, but 4 or more cesarean deliveries represent a critical level for substantially increasing the frequency of major complications. Further clinical trials are needed to evaluate not only the effects of surgical techniques and intraoperative management in women with multiple CSs, but also to investigate perioperative and long-term morbidity.</jats:p>