Boatin Adeline Adwoa, Adu-Bonsaffoh Kwame, Wylie Blair Johnson, Obed Samuel A
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 5, Boston, MA, 02114, USA.
Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana.
Matern Child Health J. 2017 Sep;21(9):1845-1852. doi: 10.1007/s10995-017-2302-3.
Objective To describe facility-based decision-making for women with one prior cesarean delivery (CD) in a resource-limited setting and to characterize maternal and perinatal outcomes in these groups. Methods One year retrospective study of women with one prior CD delivering at Korle-Bu Teaching Hospital (KBTH), Ghana. Women were categorized into three groups based on initial plan of management on admission [trial of labor after cesarean (TOLAC), emergency repeat CD (EMCD) or non-emergent repeat CD (RCD)]. Characteristics and outcomes across these groups were then compared. Results During the study period, 1247 women with one prior CD delivered at KBTH, of which 377 (30.2%) were triaged to RCD, 439 (35.2%) to EMCD and 431 (34.6%) to TOLAC. Twelve uterine ruptures and no maternal deaths occurred. Perinatal mortality was 4.2% (n = 52). Compared to the RCD group, the TOLAC group had a lower risk for maternal adverse events (aOR 0.3, 95% CI 0.1-1.0; p = 0.04) and non-significant higher risk of perinatal adverse events (aOR 1.6, 95% CI 0.7-3.3; p = 0.25). Compared to women triaged to RCD, the EMCD group had a non-significant increase in risk of maternal adverse events (aOR 1.6, 95% CI 0.8-3.5; p = 0.2) and a significantly higher rate of perinatal adverse events (aOR 2.4, 95% CI 1.2-4.9; p = 0.01). Conclusions for Practice Women triaged to EMCD at admission are different when compared to women allowed a TOLAC or offered a non-emergent RCD. These women bear increased rates of adverse outcomes and should be considered as a separate group for analysis in future studies conducted in similar settings.
目的 描述在资源有限的环境中，针对有过一次剖宫产史的女性基于医疗机构的决策制定情况，并描述这些群体的孕产妇和围产期结局。方法 对在加纳科勒-布教学医院（KBTH）分娩的有过一次剖宫产史的女性进行为期一年的回顾性研究。根据入院时的初始管理计划，将女性分为三组[剖宫产术后试产（TOLAC）、急诊再次剖宫产（EMCD）或非急诊再次剖宫产（RCD）]。然后比较这些组的特征和结局。结果 在研究期间，1247名有过一次剖宫产史的女性在KBTH分娩，其中377名（30.2%）被分诊至RCD，439名（35.2%）至EMCD，431名（34.6%）至TOLAC。发生了12例子宫破裂，无孕产妇死亡。围产期死亡率为4.2%（n = 52）。与RCD组相比，TOLAC组孕产妇不良事件风险较低（调整后比值比0.3，95%可信区间0.1 - 1.0；p = 0.04），围产期不良事件风险无显著升高（调整后比值比1.6，95%可信区间0.7 - 3.3；p = 0.25）。与分诊至RCD的女性相比，EMCD组孕产妇不良事件风险无显著增加（调整后比值比1.6，95%可信区间0.8 - 3.5；p = 0.2），围产期不良事件发生率显著更高（调整后比值比2.4，95%可信区间1.2 - 4.9；p = 0.01）。实践结论 与允许进行TOLAC或接受非急诊RCD的女性相比，入院时被分诊至EMCD的女性有所不同。这些女性不良结局发生率较高，在未来类似环境下进行的研究中，应将她们视为一个单独的分析群体。
