Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2010 Sep;49(3):254-9. doi: 10.1016/S1028-4559(10)60057-5.
Intact amniotic membranes may serve to protect the extremely fragile preterm infant from some of the mechanical forces caused by strong uterine contraction. This article introduces the technique of "en caul" cesarean delivery and reviews the experience of the National Taiwan University Hospital.
This is a prospective study carried out to perform the "en caul" cesarean delivery for early preterm labors between October 2007 and December 2008. Cases were included if the estimated birth weight was below 1,500 g or gestational age was = 32 weeks.
Twenty women including four twin pregnancies were included, and 23 neonates were born with intact membranes. Preterm labor was indicated in 16 cases, and nine of the cases were due to severe hypertensive disorders during pregnancy. Except in the case of placenta accreta, all underwent lower transverse uterine incision without wound extension. One fetus died after 3 days due to sepsis and the mortality rate was 4.3%. A total of 15 babies had an Apgar score at 5 minutes of more than seven. The value of first arterial pH was 7.278 ± 0.117 and hemoglobin was 16.1 ± 2.1 g/dL. The corrected post-menstrual age at discharge was 277.75 ± 38.56 days.
Cesarean delivery en caul is an effective and easy technique for extremely preterm fetuses to protect them from pressure trauma and also results in less uterine injury.
完整的羊膜可能有助于保护极其脆弱的早产儿免受强烈子宫收缩引起的一些机械力的影响。本文介绍了“en caul”剖宫产术的技术，并回顾了国立台湾大学医院的经验。
这是一项前瞻性研究，旨在对 2007 年 10 月至 2008 年 12 月期间的早期早产进行“en caul”剖宫产术。如果估计出生体重低于 1500 克或胎龄为=32 周，则纳入病例。
共纳入 20 例孕妇（包括 4 例双胎妊娠），23 例新生儿胎膜完整。早产的指征为 16 例，其中 9 例是由于妊娠期间严重的高血压疾病。除胎盘粘连外，所有患者均行下横行子宫切口，不延长切口。1 例胎儿因败血症于 3 天后死亡，死亡率为 4.3%。共有 15 例婴儿 5 分钟 Apgar 评分大于 7 分。动脉血 pH 值为 7.278±0.117，血红蛋白为 16.1±2.1g/dL。出院时校正的末次月经龄为 277.75±38.56 天。
“en caul”剖宫产术对极早产儿是一种有效且简单的技术，可以保护他们免受压力性损伤，还可以减少子宫损伤。
