Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Department of Obstetrics and Gynecology, Ochsner Medical Center, New Orleans, Louisiana.
Am J Perinatol. 2019 Aug;36(10):1054-1059. doi: 10.1055/s-0038-1676112. Epub 2018 Nov 30.
Our aim was to estimate the incidence of unintentional hysterotomy extension at the time of cesarean delivery and to identify associated risk factors and maternal morbidity.
We conducted a secondary analysis of a randomized controlled trial evaluating chlorhexidine-alcohol versus iodine-alcohol for skin antisepsis in women undergoing cesarean delivery. We included patients with a low transverse hysterotomy. The primary outcome was the incidence of unintentional hysterotomy extension. Logistic regression was performed to identify independent factors associated with hysterotomy extension. Maternal morbidity was compared between patients with and without extension.
Of 1,038 patients meeting the inclusion criteria, 71 (6.8%; 95% confidence interval [CI]: 5.4-8.5%) experienced a hysterotomy extension. Of several potential risk factors assessed, the second stage of labor was the only independent predictor of hysterotomy extension (adjusted odds ratio: 10.2; 95% CI: 2.6-39.8). Hysterotomy extension was associated with increased operative time (73 vs. 55.3 minutes; < 0.01), need for blood transfusion (relative risk: 5; 95% CI: 1.6-15.2), and rate of additional surgical injury (RR: 17; 95% CI: 6.9-41.8).
Hysterotomy extensions are not infrequent at the time of cesarean delivery and are associated with increased maternal morbidity. Cesarean delivery during the second stage of labor is the main independent risk factor for hysterotomy extension.
本研究旨在评估剖宫产术中意外子宫切口延长的发生率，并确定相关的风险因素和产妇发病率。
我们对一项评估氯己定-酒精与碘-酒精用于剖宫产术皮肤消毒的随机对照试验进行了二次分析。我们纳入了行子宫下段横切口剖宫产术的患者。主要结局为意外子宫切口延长的发生率。采用逻辑回归分析确定与子宫切口延长相关的独立因素。比较了子宫切口延长患者与无切口延长患者的产妇发病率。
符合纳入标准的 1038 例患者中，71 例（6.8%；95%置信区间[CI]：5.4-8.5%）发生了子宫切口延长。在评估的几个潜在风险因素中，第二产程是子宫切口延长的唯一独立预测因素（调整比值比：10.2；95%CI：2.6-39.8）。子宫切口延长与手术时间延长（73 分钟比 55.3 分钟；<0.01）、输血需求（相对风险：5；95%CI：1.6-15.2）和额外手术损伤发生率（RR：17；95%CI：6.9-41.8）增加相关。
剖宫产术中子宫切口延长并不少见，且与产妇发病率增加相关。第二产程行剖宫产术是子宫切口延长的主要独立危险因素。
