What is the average cesarean section (C-section) rate for multiparous patients?

Average Cesarean Rate in Multiparous Patients

Based on the available evidence, the average cesarean section rate in multiparous women ranges from 13.39% to 53.6%, with significant variation across different populations and healthcare settings. 1, 2

Cesarean Rates in Multiparous Women

• A 2022 study conducted in a tertiary care center found the prevalence of primary cesarean section (first C-section in women who previously delivered vaginally) was 13.39% (95% CI: 11.43-15.35) among 1,158 multiparous women 1

• In contrast, a 2004 study examining grand multiparous women (para 6 or more) with previous cesarean sections found that 53.6% underwent repeat cesarean delivery, while 46.4% attempted vaginal birth after cesarean (VBAC) 2

• Among multiparous women attempting VBAC, success rates are high, with 80.7% of grand multiparous women and 78.3% of multiparous women (para 2-5) achieving successful vaginal delivery 2

Factors Influencing Cesarean Rates in Multiparous Women

• The most common indications for primary cesarean section in multiparous women include:

  • Fetal distress (26-40.63%) 3, 1
  • Cephalopelvic disproportion (22%) 3
  • Malpresentation or malposition (16%) 3
  • Antepartum hemorrhage (13%) 3

• Elective induction of labor in multiparous women without complications does not significantly increase the risk of cesarean section (3.6% in electively induced vs. 4.3% in spontaneous labor, p=0.6670) 4

Outcomes and Complications

• Multiparous women with previous vaginal deliveries have significantly higher rates of successful vaginal birth after cesarean (95.24%) compared to those without previous vaginal deliveries (82.95%) 5

• Postoperative complications in multiparous women undergoing primary cesarean section include:

  • Wound infection (4%) 3
  • Urinary tract infection (4%) 3
  • Puerperal pyrexia (3%) 3
  • Postpartum hemorrhage (3%) 3

• Long-term complications following cesarean section include:

  • Chronic wound pain (15.4% at 3-6 months, 11.5% at 6-11 months, 11.2% at ≥12 months) 6
  • Secondary infertility (43%) 6
  • Increased risk of placenta accreta in subsequent pregnancies (12.9 per 10,000 after one cesarean section, increasing to 230 per 10,000 after five or more cesarean sections) 6

Regional and Practice Pattern Variations

• Cesarean section rates vary widely between countries and healthcare settings 6, 1

• The risk of uterine rupture after cesarean section varies significantly between countries, ranging from 8 to 68 per 10,000 births in women with previous cesarean section 6

• A WHO multicountry survey reported the incidence of uterine rupture in women with previous cesarean section was 45 per 10,000 births, ranging from 0.1% to 2.5% 6

Clinical Implications

• Multiparous women with previous vaginal deliveries have a good prognosis for successful vaginal birth, even after a cesarean section 2, 5

• High parity in association with vaginal deliveries is a good prognostic factor for successful VBAC 2

• Multiparous women require careful obstetric care during labor to maintain low cesarean section rates while ensuring good maternal and neonatal outcomes 3