Faculty of Medicine, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
PLoS One. 2023 Feb 8;18(2):e0276869. doi: 10.1371/journal.pone.0276869. eCollection 2023.
One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.
三分之一的剖宫产术（CD）为重复手术，其中大多数为低序次，第二（CD2）和第三（CD3）。本研究的目的是确定行重复低序次 CD 的女性中复杂的母体 CD 的危险因素，并为高危女性建立预测模型。这是一项在 2005-2016 年在单一医疗中心进行的回顾性纵向随访研究。在该地点行 CD2 和 CD3 的女性被纳入研究。排除胎盘植入或子宫切除术的患者。复合性母体 CD 定义为子宫破裂/裂开、输血、再次剖腹探查、入住重症监护病房或手术时间延长>90 百分位数。比较 CD2 与 CD3 之间的数据，每位女性作为自己的对照。进行单变量分析，然后进行多变量逻辑回归建模，以 OR 和 95%CI 定义显著性。研究组包括 1331 名女性。CD2 与 CD3 相比，复杂 CD 的发生率分别为 159 例（12%）和 226 例（17%），（p<0.001）。CD2 发生复杂 CD 的女性发生 CD3 并发症的风险更高，aOR 2.3（95%CI 1.5, 3.3）。撒哈拉以南非洲血统和 CD3 时早产均为 CD3 时发生复杂 CD 的危险因素，aOR 分别为 3.7（95%CI 1.9, 7.3）和 aOR 1.7（95%CI 1.1, 2.7）。多变量回归模型纳入了 1328 例病例，具有统计学意义，χ2（7）=50.760，p<0.001，解释了复合性复杂母性 CD3 变异的 6.3%，正确分类了 82.9%的病例。尽管 CD2 复杂、撒哈拉以南非洲血统和早产是 CD3 时产妇并发症的危险因素，但很难预测哪些特定的女性会出现并发症。CD2 发生复杂情况时检测 CD3 并发症的敏感性、特异性、阳性预测值和阴性预测值分别为 21%、90%、30%和 85%。
