Lira Plascencia J, Tiscareño Barajas A, Duque Segundino Y, Coria Soto I, Zambrana Castañeda M, Ibargüengoitia Ochoa F, García-Benítez C Q
Ginecol Obstet Mex. 2000 May;68:218-23.
The purpose of this study was to identify the clinical indications for the repeated cesarean section (RCS). In order to determine if the indication was an absolute or a relative one and to establish if it was justified. This is a cross sectional study of all patients with a previous cesarean delivery who underwent a RCS from January 1996 to December 1997 at the National Institute of Perinatology. Multiple pregnancies were excluded. According to the indication two groups were identified: those with an absolute indications and those with a relative one. In order to assess the differences between both groups data were analyzed through chi square test or Fisher's Exact test. During the study period there were 5,545 cesarean deliveries, 664 were RSC (11.9%). Only 641 of the RCS complied with the inclusion criteria for the study. Average maternal age was 30 years. More than half the patients under study (57.2%) did not have any pathological condition during pregnancy, and the rest (42.7%) had at least one (preeclampsia, diabetes mellitus/gestational, chronic hypertension). Indications for the previous cesarean section were absolute in 25.9% and relative in 74.1% (p = 0.0006). Indications for the RCS were also predominantly relative (70.7%), with only 29.3%) absolute (p = 0.0001). The main RCS indications were: elective (20.1%) cephalopelvic disproportion (17.8%), preeclampsia (15.4%), fetal distress (8%). Trial for vaginal delivery was undertaken in 65.4% of the absolute indications group and in 36.9% of the relative indications group (p = 0.0001). Low Apgar one minute and five minute scores were more frequent among the absolute indications group (p = 0.03 and p = 0.01 respectively). Newborns having had an absolute cesarean delivery indication entered the National Intensive Care Unit more frequently (53.6%) than those with relative indications (46.4%) (p = 0.001). The main indication for RCS in our hospital were relative, and thus it is possible to reduce the cesarean rate through a thorough assessment of all cases with a previous cesarean section, and by giving a delivery trial of all this patients.
本研究的目的是确定再次剖宫产（RCS）的临床指征。以判定该指征是绝对指征还是相对指征，并确定其是否合理。这是一项对1996年1月至1997年12月在国家围产医学研究所接受RCS的所有既往有剖宫产史患者的横断面研究。排除多胎妊娠。根据指征将患者分为两组：绝对指征组和相对指征组。为评估两组之间的差异，通过卡方检验或费舍尔精确检验对数据进行分析。研究期间共有5545例剖宫产，其中664例为再次剖宫产（11.9%）。只有641例RCS符合研究纳入标准。产妇平均年龄为30岁。研究中超过一半的患者（57.2%）孕期无任何病理状况，其余患者（42.7%）至少有一种（先兆子痫、糖尿病/妊娠期糖尿病、慢性高血压）。既往剖宫产的指征中绝对指征占25.9%，相对指征占74.1%（p = 0.0006）。RCS的指征也以相对指征为主（70.7%），绝对指征仅占29.3%（p = 0.0001）。RCS的主要指征为：选择性剖宫产（20.1%）、头盆不称（17.8%）、先兆子痫（15.4%）、胎儿窘迫（8%）。绝对指征组65.4%的患者和相对指征组36.9%的患者进行了阴道试产（p = 0.0001）。绝对指征组1分钟和5分钟阿氏评分低的情况更常见（分别为p = 0.03和p = 0.01）。有绝对剖宫产指征的新生儿进入国家重症监护病房的频率（53.6%）高于有相对指征的新生儿（46.4%）（p = 0.001）。我院RCS的主要指征为相对指征，因此通过对所有既往有剖宫产史的病例进行全面评估，并对所有这些患者进行分娩试产，有可能降低剖宫产率。
