Karavani Gilad, Chill Henry H, Reuveni-Salzman Adi, Guedalia Joshua, Ben Menahem-Zidon Ofra, Cohen Nir, Elchalal Uriel, Shveiky David
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.
J Matern Fetal Neonatal Med. 2022 Jun;35(11):2156-2161. doi: 10.1080/14767058.2020.1783230. Epub 2020 Jun 24.
Unintentional extension of uterine incision is a known complication during cesarean delivery estimated to occur in 4-8% of cesarean deliveries. The aim of this study was to examine risk factors associated with unintentional uterine incision extension and to assess which of them are independent risk factors for this condition.
We conducted a retrospective cohort study at a large public university tertiary referral center between 2003 and 2017. Included were women who underwent cesarean delivery during this time period. Demographic, medical, obstetrical and surgical data were collected. The primary outcome was the presence of uterine incision extension during cesarean delivery. Secondary outcomes included detection of risk factors associated with uterine incision extension. A multivariate analysis was additionally performed to identify general and labor related risk factors for unintentional extension of uterine incision among patients that underwent cesarean delivery during second stage of labor.
During the study period, 25,879 cesarean deliveries performed in our medical center were assessed. Out of them, 731 (2.8%) cases of unintended uterine incision extension were identified. Women in this group had high rates of full cervical dilatation and increased maternal hemorrhage. Assessment of incision extension direction revealed that two-thirds of extensions were lateral, mostly unilateral. Median size of the extension was 2.7 ± 1.2 cm.Independent parameters associated with unintended uterine incision extension included nulliparity, vertex presentation, epidural anesthesia and cesarean section indication. Further analysis including cesarean deliveries performed during the second stage of labor revealed 397 (15.3%) cesarean deliveries in which incision extension was noted and 2205 (84.7%) cesarean deliveries without incision extension. Following multivariate analysis performed in women who underwent cesarean delivery during second stage of labor, two independent parameters associated with unintended uterine incision extension remained significant - past cesarean delivery and failed vacuum attempt.
Vacuum extraction attempt and previous cesarean delivery are independent risk factors for uterine incision extension in women undergoing cesarean delivery during the second stage of labor. We also showed the majority of these extensions to be lateral.
剖宫产术中子宫切口意外延长是一种已知的并发症，据估计在4% - 8%的剖宫产中会发生。本研究的目的是检查与子宫切口意外延长相关的危险因素，并评估其中哪些是该情况的独立危险因素。
我们在一所大型公立大学三级转诊中心于2003年至2017年进行了一项回顾性队列研究。纳入在此期间接受剖宫产的女性。收集了人口统计学、医学、产科和手术数据。主要结局是剖宫产术中子宫切口延长的情况。次要结局包括检测与子宫切口延长相关的危险因素。另外对在第二产程进行剖宫产的患者进行多变量分析，以确定子宫切口意外延长的一般和产程相关危险因素。
在研究期间，对我们医疗中心进行的25,879例剖宫产进行了评估。其中，发现731例（2.8%）子宫切口意外延长病例。该组女性宫颈完全扩张率高且产妇出血增加。对切口延长方向的评估显示，三分之二的延长为侧向，大多为单侧。延长的中位大小为2.7±1.2厘米。与子宫切口意外延长相关的独立参数包括未生育、头先露、硬膜外麻醉和剖宫产指征。对包括在第二产程进行的剖宫产的进一步分析显示，397例（15.3%）剖宫产有切口延长记录，2205例（84.7%）剖宫产无切口延长。在对第二产程进行剖宫产的女性进行多变量分析后，与子宫切口意外延长相关的两个独立参数仍然显著——既往剖宫产和真空吸引失败。
真空吸引尝试和既往剖宫产是第二产程进行剖宫产的女性子宫切口延长的独立危险因素。我们还表明这些延长大多为侧向。
