塞拉利昂剖宫产围产结局：一项前瞻性多中心观察性研究。

Perinatal outcomes of cesarean deliveries in Sierra Leone: A prospective multicenter observational study.

机构信息

Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway.

出版信息

Int J Gynaecol Obstet. 2020 Aug;150(2):213-221. doi: 10.1002/ijgo.13172. Epub 2020 May 29.

DOI:10.1002/ijgo.13172

PMID:32306384

Abstract

OBJECTIVE

To analyze the indications for cesarean deliveries and factors associated with adverse perinatal outcomes in Sierra Leone.

METHODS

Between October 2016 and May 2017, patients undergoing cesarean delivery performed by medical doctors and associate clinicians in nine hospitals were included in a prospective observational study. Data were collected perioperatively, at discharge, and during home visits after 30 days.

RESULTS

In total, 1274 cesarean deliveries were included of which 1099 (86.3%) were performed as emergency surgery. Of the 1376 babies, 261 (19.0%) were perinatal deaths (53 antepartum stillbirths, 155 intrapartum stillbirths, and 53 early neonatal deaths). Indications with the highest perinatal mortality were uterine rupture (45 of 55 [81.8%]), abruptio placentae (61 of 85 [71.8%]), and antepartum hemorrhage (8 of 15 [53.3%]). In the group with cesarean deliveries performed for obstructed and prolonged labor, a partograph was filled out for 212 of 425 (49.9%). However, when completed, babies had 1.81-fold reduced odds for perinatal death (95% confidence interval 1.03-3.18, P-value 0.041).

CONCLUSION

Cesarean deliveries in Sierra Leone are associated with an exceptionally high perinatal mortality rate of 190 per 1000 births. Late presentation in the facilities and lack of adequate fetal monitoring may be contributing factors.

摘要

目的

分析塞拉利昂剖宫产的适应证及与不良围产结局相关的因素。

方法

2016 年 10 月至 2017 年 5 月，9 家医院的医生和助理临床医生行剖宫产术的患者纳入一项前瞻性观察性研究。数据在围手术期、出院时以及 30 天后的家庭访视时收集。

结果

共纳入 1274 例剖宫产术，其中 1099 例（86.3%）为急诊手术。在 1376 例婴儿中，有 261 例（19.0%）围产儿死亡（53 例产前死胎，155 例产时死胎和 53 例早期新生儿死亡）。围产儿死亡率最高的指征是子宫破裂（55 例中有 45 例[81.8%]）、胎盘早剥（85 例中有 61 例[71.8%]）和产前出血（15 例中有 8 例[53.3%]）。在因梗阻性和延长性产程而行剖宫产术的患者中，425 例中有 212 例（49.9%）填写了产程图。然而，当产程图完成时，婴儿的围产儿死亡风险降低 1.81 倍（95%置信区间 1.03-3.18，P 值 0.041）。