Reichman Orna, Hirsch Ayala, Fridman Shira, Grisaru-Granovsky Sorina, Helman Sarit
Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem 91120, Israel.
J Clin Med. 2024 Jan 28;13(3):749. doi: 10.3390/jcm13030749.
(1) : We aimed to investigate whether second-stage cesarean delivery (SSCD) had a higher occurrence of low-segment uterine incision extensions compared with cesarean delivery (CD) at other stages of labor and to study the association of these extensions with preterm birth (PTB). (2) : In this retrospective longitudinal follow-up cohort study, spanning from 2006 to 2019, all selected mothers who delivered by CD at first birth (P1) and returned for second birth (P2) were grouped by cesarean stage at P1: planned CD, first-stage CD, or SSCD. Mothers with a PTB at P1, multiple-gestation pregnancies in either P1 or P2 and those with prior abortions were excluded. (3) : The study included 1574 selected women who underwent a planned CD at P1 (n = 483 (30.7%)), first-stage CD (n = 878 (55.8%), and SSCD (n = 213 (13.5%)). There was a higher occurrence of low-segment uterine incision extensions among SSCD patients compared to first-stage CDs and planned CDs: 50/213 (23%), 56/878 (6.4%), and 5/483 (1%), respectively ( < 0.001). A multivariate logistic regression showed that women undergoing an SSCD are at risk for low-segment uterine incision extensions compared with women undergoing a planned CD, OR 28.8 (CI 11.2; 74.4). We observed no association between the occurrence of a low-segment uterine incisional extension at P1 and PTB ≤ 37 gestational weeks in the subsequent delivery, with rates of 6.3% (7/111) for those with an extension compared to 4.5% (67/1463) for those without an extension ( = 0.41). Notably, parturients experiencing a low-segment uterine incisional extension during their first childbirth were six times more likely to have a preterm delivery before 32 weeks of gestation compared to those without extensions, with two cases (1.8%) compared to four cases (0.3%), respectively. A similar trend was observed for preterm deliveries between 32 and 34 weeks of gestation, with those having extensions showing twice the prevalence of prematurity compared to those without, with a -value of 0.047. (4) : This study highlights that mothers undergoing SSCD experience higher prevalence of low uterine incision extensions compared to other CDs. To further ascertain whether the presence of these extensions is associated with preterm birth (PTB) in subsequent births, particularly early PTB before 34 weeks of gestation, larger-scale future studies are warranted.
(1)：我们旨在研究与分娩其他阶段的剖宫产（CD）相比，二期剖宫产（SSCD）时下段子宫切口延长的发生率是否更高，并研究这些延长与早产（PTB）之间的关联。(2)：在这项从2006年至2019年的回顾性纵向随访队列研究中，所有首次分娩行剖宫产（P1）且再次分娩（P2）的入选母亲按P1时的剖宫产阶段分组：计划剖宫产、一期剖宫产或二期剖宫产。排除P1时早产、P1或P2为多胎妊娠以及有既往流产史的母亲。(3)：该研究纳入了1574名入选女性，她们在P1时接受了计划剖宫产（n = 483（30.7%））、一期剖宫产（n = 878（55.8%））和二期剖宫产（n = 213（13.5%））。与一期剖宫产和计划剖宫产患者相比，二期剖宫产患者下段子宫切口延长的发生率更高：分别为50/213（23%）、56/878（6.4%）和5/483（1%）（<0.001）。多因素逻辑回归显示，与接受计划剖宫产的女性相比，接受二期剖宫产的女性有下段子宫切口延长的风险，比值比为28.8（可信区间11.2；74.4）。我们观察到P1时下段子宫切口延长的发生与后续分娩中孕周≤37周的早产之间无关联，有延长者的发生率为6.3%（7/111），无延长者为4.5%（67/1463）（P = 0.41）。值得注意的是，与无延长者相比，首次分娩时经历下段子宫切口延长的产妇在妊娠32周前早产的可能性高6倍，分别为2例（1.8%）和4例（0.3%）。在妊娠32至34周之间的早产情况也观察到类似趋势，有延长者的早产患病率是无延长者的两倍，P值为0.047。(4)：本研究强调，与其他剖宫产相比，接受二期剖宫产的母亲下段子宫切口延长的患病率更高。为了进一步确定这些延长的存在是否与后续分娩中的早产（尤其是妊娠34周前的早期早产）相关，未来需要进行更大规模的研究。
