Bujold Emmanuel, Mehta Shobha H, Bujold Camille, Gauthier Robert J
Department of Obstetrics and Gynecology, Hôpital Ste-Justine and Université de Montréal, Quebec, Canada.
Am J Obstet Gynecol. 2002 Nov;187(5):1199-202. doi: 10.1067/mob.2002.127138.
The purpose of this study was to measure the impact of the interdelivery interval on uterine rupture during subsequent delivery.
An observational cohort study was performed to assess the rate of uterine rupture in women with a previous low transverse cesarean delivery and no previous vaginal delivery who undergo a trial of labor from 1988 to 2000 in a tertiary care center. The rate of uterine rupture was measured for each of the following interdelivery intervals: <or=12 months of gestation, 13 to 24 months of gestation, 25 to 36 months of gestation, and >36 months of gestation. Multivariate logistic regression analysis was used to adjust for selected confounding variables.
Of the 1527 women who met the study criteria, the rate of uterine rupture was 4.8% for patients with an interdelivery interval of <or=12 months of gestation, 2.7 % for patients with an interval between 13 and 24 months of gestation, 0.9% for patients with an interval between 25 and 36 months of gestation, and 0.9% for patients with an interval of >36 months of gestation (P =.04). After adjustment for the confounding variables, the odds ratio for uterine rupture in women with an interdelivery interval of <or=24 months of gestation was 2.65 (95% CI, 1.08-6.46) and 4.33 (95% CI, 1.70-10.98) in women with a single-layer closure of the previous uterine incision. The combination of an interdelivery interval of <or=24 months of gestation and a single-layer closure of the previous uterine incision were associated with a rate of uterine rupture of 5.6%.
An interdelivery interval of <or=24 months of gestation was associated with a 2- to 3-fold increase in the risk of uterine rupture compared with an interval of >24 months of gestation.
本研究旨在衡量两次分娩间隔时间对后续分娩时子宫破裂的影响。
进行了一项观察性队列研究，以评估1988年至2000年在一家三级医疗中心接受过低位横切口剖宫产且未曾经阴道分娩的妇女进行引产时子宫破裂的发生率。针对以下每个两次分娩间隔时间测量子宫破裂发生率：妊娠≤12个月、妊娠13至24个月、妊娠25至36个月以及妊娠>36个月。采用多因素逻辑回归分析对选定的混杂变量进行校正。
在符合研究标准的1527名妇女中，两次分娩间隔时间为妊娠≤12个月的患者子宫破裂发生率为4.8%，间隔时间为13至24个月的患者为2.7%，间隔时间为25至36个月的患者为0.9%，间隔时间>36个月的患者为0.9%（P = 0.04）。校正混杂变量后，两次分娩间隔时间为妊娠≤24个月的妇女发生子宫破裂的比值比为2.65（95%可信区间，1.08 - 6.46），而既往子宫切口单层缝合的妇女为4.33（95%可信区间，1.70 - 10.98）。两次分娩间隔时间为妊娠≤24个月与既往子宫切口单层缝合相结合时，子宫破裂发生率为5.6%。
与妊娠>24个月的间隔时间相比，妊娠≤24个月的两次分娩间隔时间使子宫破裂风险增加2至3倍。
