Oppong S A, Tuuli M G, Seffah J D, Adanu R M K
Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Washington University School of Medicine, St Louis, Missouri, USA.
Ghana Med J. 2014 Mar;48(1):24-30. doi: 10.4314/gmj.v48i1.4.
To determine the limits of delaying caesarean section in a busy obstetric unit in a developing country setting that is not associated with neonatal survival.
Retrospective cohort study of emergency cesarean sections. Indications were sub-divided into imminent threat and no imminent threat to fetal wellbeing. The primary outcomes was a composite measure of adverse perinatal outcome including stillbirth, 5-minute Apgar score < 7 and neonatal intensive care unit admission. Effect of decision-to-delivery interval on perinatal outcomes was evaluated using Kaplan-Meier survival analysis.
495 women met inclusion criteria (142 'imminent threat' group, 353 'no imminent threat' group). The median decision-to-delivery interval was significantly shorter in the 'imminent threat' group (2.25 [95% CI 1.38 - 5.83] versus 3.42 [95% CI 1.83 - 5.85] hours, p <0.001). Only 1.7% and 12.7% sections were performed within 30 minutes and 1 hour, respectively. Risk of the composite outcome was significantly higher in the 'imminent threat group (46.5% versus 31.2%, RR=1.49 [95% CI 1.18 - 1.89], p=0.001). A 95% probability of 'live intact' survival occurred at 1 hr and 2 hrs respectively, for the imminent threat and the no imminent threat groups.
Increasing decision-to-delivery interval is associated with higher risk of adverse perinatal outcomes, but a 95% live intact survival can be achieved if the delivery occurs within 2 hours.
确定在发展中国家一个繁忙产科单位延迟剖宫产的时限，且该时限与新生儿存活无关。
对急诊剖宫产进行回顾性队列研究。指征分为对胎儿健康有即刻威胁和无即刻威胁两类。主要结局是围产期不良结局的综合指标，包括死产、5分钟阿氏评分<7分以及新生儿重症监护病房收治情况。采用Kaplan-Meier生存分析评估决定分娩间隔对围产期结局的影响。
495名妇女符合纳入标准（142名“有即刻威胁”组，353名“无即刻威胁”组）。“有即刻威胁”组的中位决定分娩间隔显著更短（2.25[95%CI 1.38 - 5.83]小时对3.42[95%CI 1.83 - 5.85]小时，p<0.001）。分别仅有1.7%和12.7%的剖宫产在30分钟和1小时内进行。“有即刻威胁”组复合结局的风险显著更高（46.5%对31.2%，RR = 1.49[95%CI 1.18 - 1.89]，p = 0.001）。“有即刻威胁”组和“无即刻威胁”组分别在1小时和2小时时“存活且无损伤”的概率为95%。
延长决定分娩间隔与围产期不良结局风险增加相关，但如果在2小时内分娩可实现95%的存活且无损伤。
