Ajmal Shameena, Farrell Thomas, Minisha Fathima, Al Obaidly Sawsan, AlQubaisi Mai, Khenyab Najat, Ali Najah, Salama Husam, Pallivalappil Abdul Rouf, Al Dewik Nader, Al Rifai Hilal
Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. Email:
Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2024 Jan 22;2024(1):3. doi: 10.5339/qmj.2024.3. eCollection 2024.
Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery, particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs.
This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs, with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications, blood loss, and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth, neonatal ICU (NICU) admission, respiratory distress syndrome (RDS), and perinatal death.
Of the 6,316 women in the study, 2,608 (41.3%) had a primary CD. 30.3%, 17.5%, and 7.3% of the cohort had their second, third, and fourth CDs, respectively. Women undergoing the 5 CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1%, p = 0.015) and postpartum hemorrhage (7.5%, p = 0.010). 24% of babies in Group 5 were born preterm (p < 0.001). They also had a 3.5 times higher risk of having a surgical complication (RR = 3.5, 95% CI 1.6-7.6, p = 0.002), a 1.8 times higher risk of developing postpartum hemorrhage (RR = 1.8, 95% CI 1.1-2.9, p = 0.014), a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR = 1.7, 95% CI 1.3-2.2, p < 0.001), a higher risk of the baby getting admitted to NICU (RR = 1.3, 95% CI 1.0-1.6, p = 0.038), and developing RDS (RR = 1.5, 95% CI 1.2-2.0, p = 0.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9, 95% CI 2.1-4.0) and RDS (RR 3.5, 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p < 0.001 for both).
Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups-consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion.
与阴道分娩相比，剖宫产（CD）会增加孕产妇和新生儿的发病率，尤其是在紧急剖宫产或多次剖宫产的情况下。这项回顾性队列研究旨在调查多次剖宫产妇女的孕产妇和新生儿并发症发生率。
本研究使用了来自一家单一的三级妇产医院的全国围产期数据库的数据。妊娠24周后通过剖宫产分娩单胎活产的妇女根据剖宫产次数分为五组，最后一组有五次或更多次剖宫产。将妇女分为有五次或更多次剖宫产的组（第5组）和少于五次剖宫产的组（第1至4组）。孕产妇结局包括术中手术并发症、失血和重症监护病房（ICU）入院。新生儿结局包括早产、新生儿重症监护病房（NICU）入院、呼吸窘迫综合征（RDS）和围产期死亡。
在研究的6316名妇女中，2608名（41.3%）进行了首次剖宫产。队列中分别有30.3%、17.5%和7.3%的妇女进行了第二次、第三次和第四次剖宫产。进行五次及以上剖宫产的妇女占其余3.5%（227名）。第5组妇女发生手术并发症的风险最高（3.1%，p = 0.015）和产后出血的风险最高（7.5%，p = 0.010）。第5组中24%的婴儿早产（p < 0.001）。与第1至4组相比，她们发生手术并发症的风险高3.5倍（RR = 3.5，95% CI 1.6 - 7.6，p = 0.002），发生产后出血的风险高1.8倍（RR = 1.8，95% CI 1.1 - 2.9，p = 0.014），在妊娠32 - 37周之间分娩的风险高1.7倍（RR = 1.7，95% CI 1.3 - 2.2，p < 0.001），婴儿入住NICU的风险更高（RR = 1.3，95% CI 1.0 - 1.6，p = 0.038），发生RDS的风险更高（RR = 1.5，95% CI 1.2 - 2.0，p = 0.002）。与早产相比，足月择期剖宫产的新生儿发生NICU入院（RR 2.9，95% CI 2.1 - 4.0）和RDS（RR 3.5，95% CI 2.3 - 5.5）等新生儿结局的风险要高得多（两者p均< 0.001）。
随着剖宫产次数的增加，孕产妇发病率显著增加。多次剖宫产新生儿发生RDS和入住NICU的风险增加反映了这些组中较低的孕周和出生体重——考虑对这些妇女术前使用类固醇促进肺成熟以降低新生儿发病率值得进一步讨论。
