Iyoke C A, Ugwu G O, Ezugwu F O, Lawani O L, Onah H E
Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria.
Niger J Clin Pract. 2014 Jul-Aug;17(4):442-8. doi: 10.4103/1119-3077.134035.
Aversion for cesarean delivery is common in our practice and risks associated with caesarean section may contribute to this phenomenon.
The objective of this study was to estimate the risks associated with subsequent pregnancies in women with one previous cesarean section in a low resource setting.
A prospective cohort study carried out at two major tertiary maternity centers in Enugu.
Maternal and perinatal outcomes were compared between women with one previous caesarean and women who had only previous vaginal deliveries.
Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential statistics at 95% of the confidence level confidence.
A total of 870 women were studied. These were divided into 435 cases and 435 controls. The absolute risk of cesarean section in a subsequent pregnancy in women with one previous cesarean was 75.8% (95% confidence interval [CI]: 72.0, 80.0). Cesarean section was significantly commoner in women with one previous cesarean compared with those who had previous vaginal delivery (Relative risk [RR] =3.78; 95% CI: 1.8, 6.2). Placenta praevia (RR = 5.0; 95% CI: 2.6, 7.2.), labor dystocia (RR = 6.4, 95% CI: 3.2, 11.2) intrapartum hemorrhage (RR = 5.0, 95% CI: 2.1, 9.3) primary postpartum hemorrhage (RR = 5.0, 95% CI: 1.5, 4.3.), blood transfusion (RR = 6.0, 95% CI: 3.4, 10.6) and Newborn special care admission (RR = 2.5; 95% CI: 1.1, 4.9) were significantly more common in women with one previous cesarean compared with those with previous vaginal deliveries. The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5).
Women who have one previous C-section face a markedly increased risk of repeat caesarean sections and feto-maternal complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of these risks while offering primary cesarean section in this low resource setting.
在我们的临床实践中，对剖宫产的抵触情绪很常见，剖宫产相关风险可能是导致这一现象的原因。
本研究旨在评估资源匮乏地区有过一次剖宫产史的女性再次妊娠的相关风险。
在埃努古的两家主要的三级妇产中心开展的一项前瞻性队列研究。
比较有过一次剖宫产史的女性与仅有过阴道分娩史的女性的母婴结局。
使用SPSS 17.0 for windows统计软件（美国纽约州阿蒙克市IBM公司）进行分析，采用描述性和推断性统计，置信水平为95%。
共研究了870名女性。她们被分为435例病例组和435例对照组。有过一次剖宫产史的女性再次妊娠时剖宫产的绝对风险为75.8%（95%置信区间[CI]：72.0，80.0）。与有过阴道分娩史的女性相比，有过一次剖宫产史的女性剖宫产明显更常见（相对风险[RR]=3.78；95%CI：1.8，6.2）。前置胎盘（RR = 5.0；95%CI：2.6，7.2）、产程延长（RR = 6.4，95%CI：3.2，11.2）、产时出血（RR = 5.0，95%CI：2.1, 9.3）、原发性产后出血（RR = 5.0，95%CI：1.5，4.3）、输血（RR = 6.0，95%CI：3.4，10.6）以及新生儿特殊护理入院（RR = 2.5；95%CI：1.1，4.9）在有过一次剖宫产史的女性中比有过阴道分娩史的女性明显更常见。剖宫产术后阴道试产失败的绝对风险为45%（95%CI：38.5，51.5）。
有过一次剖宫产史的女性在后续妊娠中面临再次剖宫产及母胎并发症的风险显著增加。在这个资源匮乏地区，尼日利亚的医生在进行初次剖宫产时需要留意这些风险。
