University of Colorado School of Medicine Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
BMC Pregnancy Childbirth. 2021 Jul 20;21(1):516. doi: 10.1186/s12884-021-04000-3.
The objective of this analysis was to observe whether maternal and perinatal/neonatal outcomes of birth vary by timing of repeat cesarean among women with a history of one prior cesarean birth in a Guatemalan cohort.
This secondary analysis was conducted using data from a prospective study conducted in communities in Chimaltenango, Guatemala through the Global Network for Women's and Children's Health Research.
Between January 2017 and April 2020, 26,465 women delivered; 3,143 (11.9%) of those women had a singleton gestation and a history of prior cesarean delivery. 2,210 (79.9%) women with a history of prior cesarean birth had data available on mode of delivery and gave birth by repeat cesarean; 1312 (59.4%) were pre-labor cesareans while 896 (40.5%) were intrapartum cesarean births. Risk factors associated with an increased risk of intrapartum cesarean birth included hospital delivery as compared to "other" location (ARR 1.6 [1.2,2.1]) and dysfunctional labor (ARR 1.6 [1.4,1.9]). Variables associated with a reduced risk of intrapartum cesarean birth were hypertensive disease (ARR 0.7 [0.6,0.9]), schooling (ARR 0.9 [0.8,0.9]), and increasing age, which was associated with a very slight reduction in the outcome (ARR 0.99 [0.98,0.99]). Maternal and neonatal outcomes did not vary by type of cesarean birth.
Outcomes of cesarean birth do not seem to vary by timing of repeat cesarean birth, with hypertensive disease increasing the likelihood of pre-labor cesarean. This information might be useful in counseling women that outcomes after failed trial of labor do not appear worse than those after pre-labor cesarean birth.
本分析旨在观察在危地马拉队列中，有一次剖宫产史的女性重复剖宫产的时间对母婴围生期/新生儿结局的影响。
本二次分析使用了在危地马拉 Chimaltenango 社区通过全球妇女儿童健康网络进行的前瞻性研究的数据。
2017 年 1 月至 2020 年 4 月期间，共有 26465 名女性分娩；其中 3143 名（11.9%）女性单胎妊娠且有剖宫产史。2210 名（79.9%）有剖宫产史的女性有分娩方式的数据，并通过重复剖宫产分娩；1312 名（59.4%）为产前剖宫产，896 名（40.5%）为产时剖宫产。与产时剖宫产相关的风险因素包括在医院分娩而不是“其他”地点（ARR 1.6[1.2,2.1]）和功能失调性分娩（ARR 1.6[1.4,1.9]）。与产时剖宫产风险降低相关的变量包括高血压疾病（ARR 0.7[0.6,0.9]）、教育程度（ARR 0.9[0.8,0.9]）和年龄增加，这与结局的轻微降低有关（ARR 0.99[0.98,0.99]）。母婴结局与剖宫产类型无关。
剖宫产结局似乎不受重复剖宫产时间的影响，高血压疾病增加了产前剖宫产的可能性。这一信息可能有助于对女性进行咨询，即试产失败后的结局似乎并不比产前剖宫产更差。
