Seffah J D
Department of Obstetrics and Gynecology, University of Ghana Medical School box 4236, Accra, Ghana.
Int J Gynaecol Obstet. 2005 Mar;88(3):253-7. doi: 10.1016/j.ijgo.2004.12.014. Epub 2005 Jan 27.
The objective of the study was to find out the indications for management and the outcomes of reopening the abdomen during the puerperium after Cesarean section.
This was a retrospective descriptive survey at the Korle Bu Teaching Hospital in Accra, Ghana.
There were 6120 Cesarean sections (17%) out of a total of 36,010 deliveries. Re-laparotomy was done in 44 patients (0.7%) of the Cesarean sections. The indications were: hemorrhage from uterine atony, hemorrhage from placental bed after operation for placenta previa, uterine sepsis with hemorrhage, hemorrhage after Cesarean section, myomectomy and hemorrhage from anterior abdominal wound dehiscence. The main surgeries performed were: hysterectomy, ligation of ascending branches of uterine arteries, ligation of hypogastric arteries, debridement and re-suturing of the uterine incision and secondary suturing of anterior abdominal wall. There were 6 near missed fatalities. There were 4 mortalities caused by excessive hemorrhage and severe sepsis.
The case fatality rate for re-laparotomy after Cesarean section is high (9%). Near missed-fatalities are common. To reduce the unfavorable outcomes, instituting more intensive education on the use of the partograph should prevent prolonged labor. Centers carrying out Cesarean section should have efficient blood transfusion service in place.
本研究的目的是找出剖宫产术后产褥期再次开腹治疗的适应证及治疗结果。
这是一项在加纳阿克拉的科勒布教学医院开展的回顾性描述性调查。
在总共36010例分娩中，剖宫产有6120例（占17%）。在44例（占剖宫产的0.7%）患者中进行了再次剖腹手术。适应证包括：子宫收缩乏力性出血、前置胎盘手术后胎盘床出血、子宫败血症伴出血、剖宫产术后出血、子宫肌瘤切除术及前腹壁伤口裂开出血。主要实施的手术包括：子宫切除术、子宫动脉上行支结扎术、髂内动脉结扎术、子宫切口清创缝合术及前腹壁二期缝合术。有6例接近死亡。有4例因大出血和严重败血症死亡。
剖宫产术后再次剖腹手术的病死率较高（9%）。接近死亡情况很常见。为减少不良后果，加强对产程图使用的教育应可预防产程延长。开展剖宫产的中心应具备有效的输血服务。
