坦桑尼亚西部农村医院的一项回顾性研究：重复剖宫产术中手术技术、粘连与发病率的关系。
Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania.
机构信息
Ndala Hospital, 15, Ndala, Tanzania.
Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands.
出版信息
BMC Pregnancy Childbirth. 2020 Oct 4;20(1):582. doi: 10.1186/s12884-020-03229-8.
BACKGROUND
The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions.
METHODS
A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012.
RESULTS
Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1 CS, 80 2 CS, 36 3 CS, 12 4 and one 5 CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2 CSs, adhesions were not associated with closure of the peritoneum at 1 CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%).
CONCLUSIONS
Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1 CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.
背景
全世界剖宫产（CS）的发生率正在上升。许多前次 CS 分娩是通过再次手术完成的，无论是择期 CS 还是试产后失败。粘连形成与再次 CS 患者的产妇发病率增加有关。尽管进行了大规模研究，但粘连形成与 CS 手术技术之间的关系仍不清楚。本研究旨在评估低收入国家（LIC）农村医院中重复 CS 的产妇和新生儿发病率和死亡率，并分析手术技术对粘连形成的影响。
方法
这是一项在 Ndala 医院于 2011 年和 2012 年进行的所有 CS 产妇的回顾性、横断面医疗记录研究。
结果
在 3966 例分娩中，有 450 例为 CS（11.3%），其中 321 例为首次 CS，80 例为二次 CS，36 例为三次 CS，12 例为四次 CS，一例为五次 CS（分别为 71%、18%、8%、3%和 0.2%）。第二次 CS 中粘连严重的比例为 56%，第三次 CS 中为 64%。在二次 CS 中，粘连与首次 CS 关闭腹膜无关，但与先前使用中线皮肤切口有关。当存在严重粘连时，产妇发病率没有增加。当存在严重粘连时，新生儿不良结局更为普遍，但无统计学意义（16%比 6%）。
结论
我们的研究结果为我们农村医院的重复 CS 实践提供了一些了解。CS 后粘连很常见，与首次 CS 时的中线皮肤切口相比，横切口更易发生粘连。回顾当地数据对于评估护理质量以及将当地结果与文献进行比较非常重要。
Zotero 插件