Department of Obstetrics and Gynaecology, University Hospital Galway, Newcastle Road, Galway, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2011 Aug;157(2):141-4. doi: 10.1016/j.ejogrb.2011.03.008. Epub 2011 Apr 5.
To audit caesarean sections performed at full cervical dilatation over a three year period in a tertiary referral centre in Ireland. To evaluate (i) the rate of caesarean deliveries in the second stage of labour, (ii) the indication for delivery and (iii) the associated fetal and maternal morbidity in this cohort of women.
This cohort study was carried out in the University Hospital Galway (UHG). Medical records of 136 consecutive women with singleton cephalic pregnancies at term, identified from the hospital database, who underwent a second stage caesarean section (CS) between 1 January 2006 and 31 December 2008, were reviewed retrospectively and demographic and outcome data were collected.
During the study period 2801/10,202 (27.5%) babies were delivered by CS. One hundred and thirty six CS (4.8%) were performed at full dilatation. The rate of CS during the second stage increased from 0.9% in 2006 to 1.8% in 2008. The majority of women were nulliparous (76.5%) and in spontaneous labour (64%). 44.1% of women had a second stage CS without a trial of instrumental delivery. 41.3% of public deliveries were attended by a consultant. The majority of babies (54%) were delivered because of a prolonged second stage with a mean duration of 146 min from full dilatation to delivery. Twenty-four of 59 primiparous women (40.7%), who underwent CS because of a prolonged second stage, did not receive oxytocin. 13.2% of babies were admitted to the neonatal intensive care unit. Estimated blood loss was documented in 67% of cases (n=91); 14.3% of women (n=13) had a postpartum haemorrhage greater than or equal to 1000 mls. 23% of these women (n=3) required a blood transfusion. The overall blood transfusion rate was 2.2%. 50% of women had a hospital stay of greater than four days.
There is a worrying rise in the overall rate of CS at full dilatation. Audit of the second stage CS rate is a useful measure of clinical standards. Strategies for improved care include increased consultant presence, meticulous documentation and ongoing training of junior obstetric staff to ensure safe intrapartum care.
The increase of second stage caesarean sections requires urgent strategies for improved care including increased consultant presence, meticulous documentation and training of junior obstetric staff.
在爱尔兰的一家三级转诊中心，对三年内完全宫颈扩张时行剖宫产的情况进行审核。评估（i）第二产程中剖宫产的发生率，（ii）分娩的指征，以及（iii）该队列中妇女的胎儿和产妇发病率。
这项队列研究在戈尔韦大学医院（UHG）进行。从医院数据库中确定了 136 名连续的足月单胎头位妊娠妇女的医疗记录，这些妇女在 2006 年 1 月 1 日至 2008 年 12 月 31 日期间接受了第二产程剖宫产，对这些记录进行了回顾性分析，并收集了人口统计学和结局数据。
在研究期间，10202 名/2801 名（27.5%）婴儿通过剖宫产分娩。136 例（4.8%）剖宫产在完全扩张时进行。第二产程剖宫产的比例从 2006 年的 0.9%增加到 2008 年的 1.8%。大多数妇女为初产妇（76.5%），处于自发性分娩（64%）。44.1%的妇女在未尝试器械分娩的情况下进行第二产程剖宫产。41.3%的公共分娩由顾问接生。大多数婴儿（54%）因第二产程延长而分娩，从完全扩张到分娩的平均时间为 146 分钟。24 名/59 名（40.7%）因第二产程延长而行剖宫产的初产妇未接受催产素。13.2%的婴儿被收入新生儿重症监护病房。67%的病例（n=91）记录了估计失血量；14.3%的妇女（n=13）产后出血量≥1000 毫升。这些妇女中有 23%（n=3）需要输血。总的输血率为 2.2%。50%的妇女住院时间超过四天。
完全宫颈扩张时行剖宫产的总体比例令人担忧地上升。对第二产程剖宫产率进行审核是评估临床标准的有效措施。改善护理的策略包括增加顾问的参与、仔细的记录和对初级产科人员的持续培训，以确保安全的分娩护理。
