Selo-Ojeme Dan, Sathiyathasan Sathevan, Fayyaz Mustabshera
Department of Obstetrics and Gynaecology, Women and Children's Directorate, Barnet and Chase Farm Hospitals NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, EN2 8JL, UK.
Arch Gynecol Obstet. 2008 Sep;278(3):245-9. doi: 10.1007/s00404-007-0548-5. Epub 2008 Jan 12.
To compare perinatal and maternal morbidity associated with caesarean sections performed in the first with that performed in the second stages of labour.
Comparative analyses between nulliparous women with singleton term pregnancies who had a caesarean section in the first stage of labour and those who had a second stage caesarean section were completed using standard statistical methods. A subgroup analysis, according to indication for caesarean section, was also performed.
Of 627 women, 81% had caesarean delivery in the first stage and 19% had caesarean delivery in the second stage of labour. Women undergoing caesarean delivery at full cervical dilatation were 1.9 times more likely to have an augmented labour (95% CI 1.2-3.4, P < 0.001) and 2.8 times more likely to have epidural anaesthesia in labour (95% CI 1.5-5.2, P < 0.001) than those in the first stage. Compared with caesarean delivery in the first stage of labour, women undergoing caesarean delivery at full cervical dilatation were 4.6 times more likely to have composite intraoperative complications (95% CI 2.7-7.9, P < 0.001), 3.1 times more likely to have blood loss greater than 1,000 ml (95% CI 1.3-7.4, P = 0.01), and 2.9 times more likely to have a blood transfusion (95% CI 1.5-5.6, P < 0.001). The risk of neonatal morbidity was higher in first stage caesareans when they were performed for presumed fetal compromise (66.3 vs. 26.3%, P = 0.002), and lower when they were performed for failure to progress (18.4 vs. 42%, P = 0.02).
Caesarean section in the second stage of labour is associated with a higher risk of maternal but not perinatal morbidity.
比较第一产程剖宫产与第二产程剖宫产的围产期及产妇发病率。
采用标准统计方法，对单胎足月妊娠的初产妇中，在第一产程行剖宫产的产妇与在第二产程行剖宫产的产妇进行比较分析。还根据剖宫产指征进行了亚组分析。
627名女性中，81%在第一产程行剖宫产，19%在第二产程行剖宫产。宫颈完全扩张时行剖宫产的女性，其引产的可能性比第一产程剖宫产的女性高1.9倍（95%可信区间1.2 - 3.4，P < 0.001），产时硬膜外麻醉的可能性高2.8倍（95%可信区间1.5 - 5.2，P < 0.001）。与第一产程剖宫产相比，宫颈完全扩张时行剖宫产的女性发生术中综合并发症的可能性高4.6倍（95%可信区间2.7 - 7.9，P < 0.001），失血超过1000 ml的可能性高3.1倍（95%可信区间1.3 - 7.4，P = 0.01），输血的可能性高2.9倍（95%可信区间1.5 - 5.6，P < 0.001）。当第一产程剖宫产是因推测胎儿窘迫而行时，新生儿发病风险较高（66.3%对26.3%，P = 0.002），而因产程无进展而行时，新生儿发病风险较低（18.4%对42%，P = 0.02）。
第二产程剖宫产与产妇发病率较高相关，但与围产期发病率无关。
