Early-Onset Labor in Women with Multiple Cesarean Scars Scheduled for Elective Repeat Cesarean Delivery: Incidence and Outcomes from a Retrospective Study in Ethiopia

Background: Early-onset labor among women with multiple cesarean scars poses unique maternal and neonatal risks, particularly in resource-limited settings. Despite growing numbers of women with repeat cesarean sections (RCS) in Ethiopia, evidence on outcomes in this high-risk group remains limited. Methods: We conducted a descriptive, retrospective study at Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from January 2023 to December 2024. All women with ≥2 prior cesarean deliveries who underwent scheduled RCS were included, excluding cases converted to emergency cesarean for non-labor-related indications. Early-onset labor was defined as spontaneous labor or rupture of membranes before 39 weeks’ gestation. Data were analyzed using descriptive statistics. Results: Of 460 women with ≥2 prior cesarean scars, 86 (19.0%) experienced early-onset labor, including 8.6% who delivered preterm (<37 weeks). The mean maternal age was 32 years; 96.5% resided in Addis Ababa. Most women had two prior cesareans (65.1%). Surgical complications included scar dehiscence (10.4%), endometritis (10.4%), wound infection (4.6%), and urologic injury (17.5%). NICU admission occurred in 12.8% of neonates, with neonatal mortality at 25%. Preterm birth strongly correlated with neonatal morbidity and mortality. Conclusion: The study showed that one in five women with multiple cesarean scars scheduled for elective CS at 39 weeks experienced early-onset labor requiring emergency RCS before 39 weeks, resulting in significant maternal and neonatal complications. spontaneous preterm labor is also common. These findings support consideration of scheduling elective RCS before 39 weeks in this population. Pregnant women with multiple scar may benefit from Preventive interventions such as cervical length screening for preterm labor.