Nakimuli Annettee, Nakubulwa Sarah, Kakaire Othman, Osinde Michael O, Mbalinda Scovia N, Nabirye Rose C, Kakande Nelson, Kaye Dan K
Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
Department of Obstetrics and Gynecology, Jinja Regional Hospital, Jinja, Uganda.
BMC Res Notes. 2015 Oct 30;8:624. doi: 10.1186/s13104-015-1617-7.
Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section.
This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12.
There were 25,846 deliveries during the study period, of which 20,083 (77.7%) were vaginal deliveries or assisted deliveries, and 5763 (22.3%) were caesarean sections. Of the caesarean sections, 920 (15.9%) were ECS. The commonest maternal morbidity was hemorrhage (17.2%). A birth weight less than 2500 g (aRR 11.0 [95% CI 8.1-17.2]) or more than 4000 g (aRR 12.2 [95% CI 10.6-23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95% 1.20-2.10]), multigravidity (aRR 1.70 [95% CI 1.20-2.90]) and using general anaesthesia (aRR 2.43 [95% CI 1.20-5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used.
Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.
择期剖宫产与新生儿不良结局风险增加有关。主要目的是评估择期剖宫产分娩后新生儿发病的发生率和决定因素。次要目的是描述与择期剖宫产相关的产妇发病率。
这是一项对因择期剖宫产入院的妇女及其新生儿进行的前瞻性队列研究，于2013年3月1日至2014年2月28日在穆拉戈医院进行。从手术时起对其进行随访，直至剖宫产分娩后住院6周。通过访员管理的问卷收集数据，并查阅医疗记录以获取人口统计学特征、产科病史、当前妊娠并发症和直至出院的妊娠结局。研究结局为产妇和新生儿发病率。使用Stata 12版本对数据进行分析。
研究期间共有25846例分娩，其中20083例（77.7%）为阴道分娩或辅助分娩，5763例（22.3%）为剖宫产。在剖宫产中，920例（15.9%）为择期剖宫产。最常见的产妇发病率是出血（17.2%）。出生体重低于2500克（调整风险比11.0[95%可信区间8.1 - 17.2]）或高于4000克（调整风险比12.2[95%可信区间10.6 - 23.2]）、妊娠龄小于或等于38周分娩（调整风险比1.62[95% 1.20 - 2.10]）、多胎妊娠（调整风险比1.70[95%可信区间1.20 - 2.90]）以及使用全身麻醉（调整风险比2.43[95%可信区间1.20 - 5.90]）与新生儿发病风险相关。最常见的新生儿发病率是呼吸窘迫，尤其是在妊娠龄37周或更低、出生体重低于2500克或高于4000克以及使用全身麻醉的情况下分娩。
我们的研究表明，在穆拉戈医院，择期剖宫产与显著的新生儿和产妇发病率相关。我们建议在妊娠39周后进行择期剖宫产，并且最好避免使用全身麻醉。
