Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel.
The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.
Fetal Diagn Ther. 2020;47(7):565-571. doi: 10.1159/000504573. Epub 2020 Jan 24.
While endeavors to reduce cesarean delivery (CD) rates are given priority worldwide, it is important to evaluate if these efforts place parturients and neonates at risk. CD performed in the second stage of labor carries higher risks of maternal and fetal complications and is a more challenging surgical procedure than that performed in the first stage or before labor. In a population with a low CD rate, we sought to evaluate the rate of maternal and fetal complications associated with unplanned CD (UCD) performed in the second vs. the first stage of labor, in primiparas and multiparas, as well as the risk factors leading to and the complications associated with UCD in the second stage of labor in this low-CD rate setting.
This was a retrospective, electronic medical record-based study of 7,635 term and preterm singletons born via UCD in the period 2003-2015. Maternal and neonatal background and outcome parameters were compared between groups. Logistic regression modeling was applied to adjust for clinically and statistically significant risk factors.
UCD was more likely to be performed in the second stage of labor in mothers delivering larger fetuses (head circumference and body weight ≥90 centile) and those with persistent occiput posterior (POP) presentation. UCD in the second stage was strongly associated with serious maternal complications (excessive hemorrhage and fever) compared to UCD performed in the first stage, in both primiparas and multiparas.
UCD performed in the second stage of labor, while less frequent than first-stage UCD, is more likely with larger neonates and POP presentation, and is associated with a higher rate of maternal complications in primiparas and multiparas. Complication rates in our low-CD-rate population did not exceed those reported in the literature from high-CD-rate areas.
尽管全世界都在努力降低剖宫产率（CD），但评估这些努力是否使产妇和新生儿面临风险非常重要。第二产程的 CD 会增加母婴并发症的风险，并且比第一产程或产程前进行的手术更具挑战性。在 CD 率较低的人群中，我们评估了计划性剖宫产（UCD）与第二产程和第一产程相比，在初产妇和经产妇中与 UCD 相关的母婴并发症发生率，以及导致第二产程 UCD 的危险因素以及与第二产程 UCD 相关的并发症。
这是一项回顾性、基于电子病历的研究，纳入了 2003 年至 2015 年间经 UCD 分娩的 7635 例足月和早产单胎。比较了两组产妇和新生儿的背景和结局参数。应用逻辑回归模型调整了临床和统计学上有意义的危险因素。
在分娩较大胎儿（头围和体重≥90 百分位数）和持续性枕后位（POP）的产妇中，第二产程 UCD 更有可能发生。与第一产程 UCD 相比，第二产程 UCD 与严重的母亲并发症（大量出血和发热）密切相关，无论初产妇还是经产妇均如此。
第二产程 UCD 的发生频率虽低于第一产程 UCD，但与较大的新生儿和 POP 表现更相关，与初产妇和经产妇的母亲并发症发生率更高相关。在我们的 CD 率较低的人群中，并发症发生率并未超过高 CD 率地区文献报道的发生率。
