Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA.
Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, MD, USA.
J Matern Fetal Neonatal Med. 2021 Jul;34(14):2290-2294. doi: 10.1080/14767058.2019.1663819. Epub 2019 Sep 16.
Cesarean delivery between 23 and 27 weeks' gestation is a risk factor for performing classical and inverted T uterine incisions. When attempting cesarean delivery via a low transverse incision at a very preterm gestational age, having difficulty in delivery of the fetus may require conversion to an inverted T-incision. We sought to examine maternal short-term outcomes according to the type of attempted uterine incisions in preterm deliveries.
This was a multihospital retrospective cohort study of women undergoing cesarean delivery between 23 0/7 and 27 6/7 week' gestation from 2005 through 2014. Cases were classified as attempting low transverse incision if the uterine incision was a low transverse or an inverted T incision. Composite maternal outcome (postpartum hemorrhage, transfusion, endometritis, sepsis, wound infection, deep venous thrombosis/pulmonary embolism, hysterectomy, respiratory complications, and intensive care unit admission) was compared between cases where a low transverse incision was attempted and those with a classical uterine incision. We also examined operative time and Apgar score at 5 minutes. Multivariable logistic regression or linear regression was used to obtain adjusted -value or adjusted odds ratios (aOR) with 95% confidence interval (95%CI), controlling for maternal age, gestational age, body mass index (kg/m), and preterm premature rupture of membranes.
Of 311 women undergoing cesarean delivery between 23 0/7 and 27 6/7 week' gestation, attempting low transverse incision occurred in 127 (41%). Of these, conversion to an inverted T or J uterine incision occurred in 14 (11%). There was no difference in the composite outcome between cases with attempting low transverse incision and those with classical incision (17.3 versus 23.4%, respectively; aOR 0.58 [95%CI 0.30-1.11]). Cases in which a low transverse uterine incision was attempted had shorter median operative time (46 versus 55 minutes; adjusted -value < 0.01). No differences were seen in the Apgar score at 5 minutes (adjusted -value = .81).
The incidence of conversion from a low transverse to an inverted T uterine incision in very preterm cesarean deliveries was low. Attempting a low transverse compared to a classical uterine incision was associated with similar odds of the primary outcome and shorter operative time.
23 至 27 周妊娠之间的剖宫产术是行经典式和倒 T 式子宫切口的危险因素。当极早产时尝试经子宫下段横切口行剖宫产术，分娩胎儿困难时可能需要转换为倒 T 式切口。我们旨在根据极早产时尝试的子宫切口类型来检查产妇的短期结局。
这是一项多医院回顾性队列研究，纳入了 2005 年至 2014 年期间 23 0/7 至 27 6/7 周妊娠行剖宫产术的妇女。如果子宫切口为横行或倒 T 形切口，则将病例归类为尝试经子宫下段横切口。复合产妇结局（产后出血、输血、子宫内膜炎、败血症、伤口感染、深静脉血栓形成/肺栓塞、子宫切除术、呼吸并发症和重症监护病房入院）比较尝试经子宫下段横切口的病例与行经典式子宫切口的病例。我们还检查了手术时间和 5 分钟时的 Apgar 评分。采用多变量逻辑回归或线性回归获得调整后 -值或调整后的优势比（aOR）及其 95%置信区间（95%CI），控制产妇年龄、妊娠周数、体重指数（kg/m）和早产胎膜早破。
在 311 例行 23 0/7 至 27 6/7 周妊娠剖宫产术的妇女中，有 127 例（41%）尝试经子宫下段横切口。其中，14 例（11%）转为倒 T 形或 J 形切口。尝试经子宫下段横切口的病例与行经典式子宫切口的病例之间的复合结局无差异（分别为 17.3%和 23.4%；aOR 0.58 [95%CI 0.30-1.11]）。尝试经子宫下段横切口的病例手术时间中位数更短（46 分钟比 55 分钟；调整后 -值＜0.01）。5 分钟时 Apgar 评分无差异（调整后 -值=0.81）。
极早产剖宫产术中从子宫下段横切口转为倒 T 形切口的发生率较低。与经典式子宫切口相比，尝试经子宫下段横切口与原发性结局的几率相似，且手术时间更短。
