Imbert P, Berger F, Diallo N S, Cellier C, Goumbala M, Ka A S, Petrognani R
Service des maladies infectieuses et tropicales, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France.
Med Trop (Mars). 2003;63(4-5):351-7.
The prognosis of emergency cesarean section is poor for both the mother and child in developing countries. The respective impact of obstetrical and surgical factors has rarely been analyzed. This prospective study was carried out in 370 women (mean age, 30.5 years) who underwent emergency cesarean section at Principal Hospital in Dakar, Senegal, between January 1 and December 31, 1997. Fifty percent of these women had been transferred from an outside maternity clinic. Indications related to the mother (75% of cases) or fetus (25% of cases) were divided into two groups according to degree of emergency: absolute (n = 163) and relative (n = 207). Placental hematoma (n = 64) and fetus-pelvis size mismatching (n = 49) were the main indications in both groups. The technique chosen for initial anesthesia performed by a specialized nurse in most cases was either spinal anesthesia if there were no contraindications (50.8%) or general anesthesia (49.2%). There were 5 complications including 1 that was fatal (aspiration during intubation for general anesthesia). The postoperative maternal morbidity rate was low (n = 7) and outcome was favorable. A total of 7 patients (1.9%) died due to anesthesia-related events in 1 case and obstetrical factors in 6. Mortality in the absolute emergency group was significantly higher for women who were transferred from other clinics (p < 0.02). Child mortality (n = 87) occurred prior to delivery in two thirds of cases and after delivery in one third. Child mortality was significantly higher in the absolute emergency group (RR = 5.4; IC95% = 3.2-8.9, p < 10(-6)). Mother and child mortality rates were correlated with the severity of obstetrical manifestations and delay of care. Findings also showed that a well-organized care system lowers the operative risk of emergency cesarean section even in developing countries.
在发展中国家，急诊剖宫产对母婴的预后都很差。产科因素和手术因素各自的影响很少被分析。这项前瞻性研究对1997年1月1日至12月31日期间在塞内加尔达喀尔市主要医院接受急诊剖宫产的370名妇女（平均年龄30.5岁）进行。这些妇女中有50%是从外部产科诊所转诊而来的。与母亲相关的指征（75%的病例）或胎儿相关的指征（25%的病例）根据紧急程度分为两组：绝对紧急（n = 163）和相对紧急（n = 207）。两组的主要指征均为胎盘血肿（n = 64）和胎儿与骨盆大小不匹配（n = 49）。在大多数情况下，由专业护士进行的初始麻醉所选择的技术，若没有禁忌证则为脊髓麻醉（50.8%）或全身麻醉（49.2%）。共有5例并发症，其中1例致命（全身麻醉插管时误吸）。术后产妇发病率较低（n = 7），结局良好。共有7例患者（1.9%）死亡，1例死于与麻醉相关的事件，6例死于产科因素。从其他诊所转诊而来的妇女在绝对紧急组中的死亡率显著更高（p < 0.02）。三分之二的病例中儿童死亡（n = 87）发生在分娩前，三分之一发生在分娩后。绝对紧急组中的儿童死亡率显著更高（RR = 5.4；95%置信区间 = 3.2 - 8.9，p < 10(-6)）。母婴死亡率与产科表现的严重程度以及护理延迟相关。研究结果还表明，即使在发展中国家，一个组织良好的护理系统也能降低急诊剖宫产的手术风险。
