Corry Edward M A, Ramphul Meenakshi, Rowan Ann M, Segurado Ricardo, Mahony Rhona M, Keane Declan P
Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland.
School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2018 May;224:188-191. doi: 10.1016/j.ejogrb.2018.03.031. Epub 2018 Mar 20.
The rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally.
The objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences.
Retrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit's electronic database for 2015.
The rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80-5.33 kg) vs 3.48 kg (1.53-4.40 kg)). There was no difference in neonatal morbidity.
Fetal head malposition is associated with a higher risk of full dilatation caesarean section. Interestingly, maternal and fetal morbidity were similar between full dilatation caesarean sections and anticipated difficult operative vaginal deliveries carried out in theatre. The management of labour in terms of the decision to use oxytocin judiciously in hope of correcting inefficient uterine contractions and continuous labour ward training, particularly the diagnosis of malposition and its correction may be beneficial in reducing the rate of full dilation caesarean sections.
宫颈完全扩张时的剖宫产率及其高发病风险持续上升，反映出国际上剖宫产率的总体增长。
本研究的目的是确定三级转诊单位中宫颈完全扩张时的剖宫产率，并评估可能与这些分娩相关的关键产程、母体和胎儿因素。我们还评估了宫颈完全扩张时剖宫产的母体和胎儿发病率。在可能的情况下，将这些情况与在手术室进行的成功阴道助产分娩进行比较，以确定关键差异。
回顾性队列研究。我们回顾了10年间宫颈完全扩张时的剖宫产率。我们分析了单头位妊娠≥34周的分娩（剖宫产或阴道助产分娩），并从我们单位2015年的电子数据库中同时收集数据。
在十年期间，宫颈完全扩张时的剖宫产率增加了三分之一以上（56/6947（0.80%）对92/7378（1.24%），p = 0.01）。在符合纳入标准的84例宫颈完全扩张时的剖宫产中，63例（75%）为初产妇，平均产妇年龄为33（±５）岁。在不到一半的第二产程剖宫产中（记录的57例中有22例，38.６%）在第二产程使用了缩宫素。与成功的阴道助产分娩相比，宫颈完全扩张时的剖宫产中胎儿头位异常（枕后位或枕横位）更多（41/46（89.1%）对2/21（9.5%），p<0.001）。宫颈完全扩张时的剖宫产和阴道助产分娩中，严重产后出血（定义为估计失血量≥1000 ml）的发生率相似。与阴道助产分娩相比，宫颈完全扩张时的剖宫产的平均出生体重没有差异（3.88 kg（2.80-5.33 kg）对3.48 kg（1.53-4.40 kg））。新生儿发病率没有差异。
胎儿头位异常与宫颈完全扩张时剖宫产的较高风险相关。有趣的是，宫颈完全扩张时的剖宫产与预期在手术室进行的困难阴道助产分娩之间的母体和胎儿发病率相似。在产程管理方面，明智地决定使用缩宫素以纠正无效宫缩，并持续进行产房培训，特别是对头位异常的诊断及其纠正，可能有助于降低宫颈完全扩张时的剖宫产率。
