Qazi Gul Rukh, Akhtar Shahnaz
Department of Obstetrics and Gynaecology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar.
J Coll Physicians Surg Pak. 2007 Oct;17(10):611-4. doi: 10.2006/JCPSP.611614.
To determine the clinical and epidemiological characteristics in patients having their first cesarean section (FCS) and compare it with findings in patients with repeated cesarean section (RCS).
A cross-sectional, comparative study.
Unit 'A' of the Department of Obstetrics and Gynaecology, Postgraduate Medical Institute of Lady Reading Hospital, Peshawar, Pakistan, from January to December 2005.
This study included all the women who gave birth by cesarean sections, 817 of the total 5992 deliveries, at this unit during the study period. Data on potential risk factors for the first cesarean section (FCS) and repeated cesarean section (RCS) were extracted from medical records, which were reviewed and compared between these two groups of women. Data were statistically analyzed with student t-test for comparison between means and Chi-square test for comparison between percentages. Crude odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Significance was taken at p < 0.05.
The incidence of cesarean sections was 13.62% of the total deliveries, with the FCS frequency of 70.13 % (573) and RCS frequency of 29.87% (244). The three most frequent indications for FCS were dystocia and cephalopelvic disproportion (42.8%), fetal distress (18.5%), and abnormal presentation (32.1%). Meanwhile, those for RCS were previous cesarean section (41%), dystocia (27.5%) and abnormal presentation (15.2%). The factors significantly associated with FCS were: age < 20 years, first pregnancy, premature rupture of membranes, antecedent of labor room induction and neonatal weight above 3500 g (p < 0.05). More cases of emergency cesarean sections, antipartum hemorrhage, malpresentations and traditional birth attendants (TBA's) handling were encountered in the FCS group (p < 0.05). Percentages of second gravidity and multigravidity were greater in RCS patients. Fetal outcome was also good in the RCS group. No difference between the groups was found regarding educational level and prenatal consultations (p > 0.05).
The frequency of first cesarean section and repeat cesarean section is high in our setup. Adequate following of the programs to diminish the percentage of FCS by curtailing its predisposing factors is needed.
确定首次剖宫产（FCS）患者的临床和流行病学特征，并与再次剖宫产（RCS）患者的结果进行比较。
一项横断面比较研究。
2005年1月至12月，巴基斯坦白沙瓦市雷丁夫人医院研究生医学研究所妇产科A单元。
本研究纳入了研究期间在该科室通过剖宫产分娩的所有妇女，在总共5992例分娩中有817例。从医疗记录中提取首次剖宫产（FCS）和再次剖宫产（RCS）潜在风险因素的数据，并在这两组妇女之间进行审查和比较。数据采用学生t检验进行均值比较，采用卡方检验进行百分比比较。计算粗比值比（OR）及其95%置信区间（95%CI）。以p<0.05为有统计学意义。
剖宫产发生率占总分娩数的13.62%，其中首次剖宫产频率为70.13%（573例），再次剖宫产频率为29.87%（244例）。首次剖宫产最常见的三个指征是难产和头盆不称（42.8%）、胎儿窘迫（18.5%）和胎位异常（32.1%）。同时，再次剖宫产的指征是既往剖宫产史（41%）、难产（27.5%）和胎位异常（15.2%）。与首次剖宫产显著相关的因素有：年龄<20岁、初孕、胎膜早破、产房引产史和新生儿体重>3500g（p<0.05）。首次剖宫产组急诊剖宫产、产前出血、胎位异常和传统接生员接生的病例更多（p<0.05）。再次剖宫产患者中二胎及多胎妊娠的百分比更高。再次剖宫产组胎儿结局也较好。两组在教育水平和产前咨询方面无差异（p>0.05）。
在我们的研究机构中，首次剖宫产和再次剖宫产的频率较高。需要充分执行相关计划，通过减少其诱发因素来降低首次剖宫产的比例。
