子宫缝合术在子宫破裂风险中的作用。
The role of uterine closure in the risk of uterine rupture.
机构信息
From the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada, the Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada, and the Department of Obstetrics & Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec Canada, and the Department of Obstetrics & Gynaecology, Hôpital Lasalle, Lasalle, Quebec, Canada; the Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada, and the Department of Obstetrics & Gynaecology, Faculty of Medicine, St Mary's Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Royal Victoria Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Royal Victoria Hospital, McGill University, Montréal, Quebec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Royal Victoria Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Jewish General Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Lasalle, Lasalle, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Lasalle, Lasalle, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Pierre-Boucher, Longueuil, Quebec, Canada; the Department of Obstetrics & Gynaecology, Centre Hospitalier Cité de la Santé, Laval, Quebec, Canada; Department of Obstetrics & Gynaecology, Hôpital Sacré-Coeur, Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada, and the Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada; and the Department of Obstetrics & Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
出版信息
Obstet Gynecol. 2010 Jul;116(1):43-50. doi: 10.1097/AOG.0b013e3181e41be3.
OBJECTIVE
To evaluate the effects of prior single-layer compared with double-layer closure on the risk of uterine rupture.
METHODS
A multicenter, case-control study was performed on women with a single, prior, low-transverse cesarean who experienced complete uterine rupture during a trial of labor. For each case, three women who underwent a trial of labor without uterine rupture after a prior low-transverse cesarean delivery were selected as control participants. Risk factors such as prior uterine closure, suture material, diabetes, prior vaginal delivery, labor induction, cervical ripening, birth weight, prostaglandin use, maternal age, gestational age, and interdelivery interval were compared between groups. Conditional logistic regression analyses were conducted.
RESULTS
Ninety-six cases of uterine rupture, including 28 with adverse neonatal outcome, and 288 control participants were assessed. The rate of single-layer closure was 36% (35 of 96) in the case group and 20% (58 of 288) in the control group (P<.01). In multivariable analysis, single-layer closure (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.37-5.28) and birth weight greater than 3,500 g (OR 2.03; 95% CI 1.21-3.38) were linked with increased rates of uterine rupture, whereas prior vaginal birth was a protective factor (OR 0.47; 95% CI 0.24-0.93). Single-layer closure was also related to uterine rupture associated with adverse neonatal outcome (OR 2.89; 95% CI 1.01-8.27).
CONCLUSION
Prior single-layer closure carries more than twice the risk of uterine rupture compared with double-layer closure. Single-layer closure should be avoided in women who could contemplate future vaginal birth after cesarean delivery.
LEVEL OF EVIDENCE
II.
目的
评估单层与双层缝合对子宫破裂风险的影响。
方法
对经历经阴道试产中完全性子宫破裂的既往单一横行剖宫产且再次妊娠的妇女进行多中心病例对照研究。每例子宫破裂的病例，选择 3 例既往剖宫产且再次妊娠行经阴道试产但未发生子宫破裂的妇女作为对照。对比两组产妇的既往子宫缝合方式、缝合材料、糖尿病、既往阴道分娩史、引产、宫颈成熟、出生体重、前列腺素使用、产妇年龄、孕周和两次分娩间隔等风险因素。行条件 logistic 回归分析。
结果
共评估了 96 例子宫破裂病例，其中 28 例新生儿结局不良和 288 例对照。病例组中单层缝合率为 36%（35/96），对照组为 20%（58/288）（P<.01）。多变量分析显示，单层缝合（比值比 [OR]2.69；95%置信区间 [CI]1.37-5.28）和出生体重大于 3500 g（OR2.03；95% CI 1.21-3.38）与子宫破裂发生率增加相关，而既往阴道分娩是保护因素（OR0.47；95% CI 0.24-0.93）。单层缝合也与不良新生儿结局相关的子宫破裂相关（OR2.89；95% CI 1.01-8.27）。
结论
与双层缝合相比，既往单层缝合与子宫破裂的风险增加两倍以上。对于有再次经阴道分娩意愿的剖宫产妇女，应避免单层缝合。
证据等级
II。
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