Peled Tzuria, Saar Noa, Muraca Giulia M, Sela Hen Y, Grisaru-Granovsky Sorina, Rottenstreich Misgav
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Am J Perinatol. 2025 Apr;42(5):572-579. doi: 10.1055/a-2408-7813. Epub 2024 Sep 3.
This study aims to estimate the frequency of unintended upper uterine wall extensions during cesarean delivery (CD) and identify associated risk factors and adverse outcomes.A multicenter retrospective cohort study was conducted, including patients who underwent CD between 2005 and 2021. Demographic factors, obstetric history, CD indications, delivery and surgical characteristics, adverse maternal and neonatal outcomes were compared between those with unintended upper uterine wall extensions during CD and those without extensions. Crude and adjusted estimates (odds ratios [ORs] and 95% confidence intervals [CIs]) were used.Among 30,517 patients meeting inclusion criteria, 117 (0.4%) had an unintended upper uterine wall extension. In univariate analysis, upper uterine wall extensions were associated with higher rates of intrapartum CD, second-stage CD, unplanned or emergency CD, CD following failed vacuum delivery or trial of labor after CD, chorioamnionitis, prolonged labor, increased vaginal exams, lower fetal head station, and higher birth weight. During surgery, higher rates of general anesthesia, significant intraperitoneal adhesion, fetal malpresentation, and fetal extraction by the leg were observed. Multivariable analysis identified fetal extraction not by head (adjusted OR [aOR]: 9.17, 95% CI: 5.35-15.73), vertex fetal presentation (aOR: 3.65, 95% CI: 1.81-7.35), second-stage CD (aOR: 3.07, 95% CI: 1.24-7.59), and trial of labor after cesarean (aOR: 2.04, 95% CI: 1.08-3.84) as significant risk factors for unintended upper uterine wall extensions. Additionally, upper uterine wall extensions were associated with higher rates of maternal and neonatal complications, including longer operating times, excessive bleeding, postpartum hemorrhage, intraperitoneal drainage, blood product transfusion, puerperal fever, paralytic ileus, Apgar score < 7 at 1 and 5 minutes, and fetal intracranial hemorrhage.Our study identifies risk factors for unintended upper uterine wall extensions during CD. While these extensions are infrequent, their occurrence is associated with increased maternal and neonatal morbidity. · Unintended upper uterine wall extensions occur in 0.4% of cesarean deliveries.. · Significant risk factors include fetal extraction not by head and second-stage CD.. · Extensions are associated with increased maternal complications like excessive bleeding and prolonged surgery.. · Neonatal complications include lower Apgar scores and intracranial hemorrhage.. · Awareness of these risks is critical for improving cesarean delivery outcomes..
本研究旨在评估剖宫产术中意外子宫前壁延伸的发生率，并确定相关危险因素及不良结局。开展了一项多中心回顾性队列研究，纳入2005年至2021年期间接受剖宫产的患者。比较了剖宫产术中发生意外子宫前壁延伸的患者与未发生延伸的患者在人口统计学因素、产科病史、剖宫产指征、分娩及手术特征、母婴不良结局等方面的差异。采用粗估计值和校正估计值（比值比[ORs]及95%置信区间[CIs]）。
在30517例符合纳入标准的患者中，117例（0.4%）发生了意外子宫前壁延伸。单因素分析显示，子宫前壁延伸与产时剖宫产、第二产程剖宫产、计划外或急诊剖宫产、真空吸引分娩失败或剖宫产术后试产失败后的剖宫产、绒毛膜羊膜炎、产程延长、阴道检查次数增加、胎头位置较低及出生体重较高的发生率较高有关。手术过程中，观察到全身麻醉、显著腹腔粘连、胎位异常及拉腿助产的发生率较高。多变量分析确定非头位助产（校正OR[aOR]：9.17，95%CI：5.35 - 15.73）、头先露（aOR：3.65，95%CI：1.81 - 7.35）、第二产程剖宫产（aOR：3.07，95%CI：1.24 - 7.59）及剖宫产术后试产（aOR：2.04，95%CI：1.08 - 3.84）是意外子宫前壁延伸的显著危险因素。此外，子宫前壁延伸与母婴并发症发生率较高有关，包括手术时间延长、出血过多、产后出血、腹腔引流、输血、产褥热、麻痹性肠梗阻、1分钟和5分钟时Apgar评分<7分以及胎儿颅内出血。
我们的研究确定了剖宫产术中意外子宫前壁延伸的危险因素。虽然这些延伸情况并不常见，但其发生与母婴发病率增加有关。· 0.4%的剖宫产术中会发生意外子宫前壁延伸。· 显著危险因素包括非头位助产和第二产程剖宫产。· 延伸与出血过多和手术时间延长等母亲并发症增加有关。· 新生儿并发症包括Apgar评分较低和颅内出血。· 了解这些风险对于改善剖宫产结局至关重要。
