Maor Gil Shechter, Shapira Ziv, Bar Chen Manor, Moore Shiran Sara, Yagur Yael, Biron-Shental Tal, Weitzner Omer
Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St, Kfar Saba, Israel.
School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2024 Dec;310(6):2915-2920. doi: 10.1007/s00404-024-07787-6. Epub 2024 Oct 22.
To compare the immediate and late complications associated with emergent cesarean sections (CS) performed during the first and second stages of active labor.
We conducted a retrospective analysis of electronic medical records from a single academic center, including data from 577 patients who underwent emergent cesarean sections at 4 cm or more of cervical dilatation. Patients were divided into two groups: those who had CS during the first stage of labor (4-9 cm dilatation) and those who had CS at complete dilatation (10 cm). Maternal and neonatal outcomes were compared, including rates of complications such as uterine atony, post-partum hemorrhage, infection, and neonatal intensive care unit (NICU) admission.
Of the 577 patients, 352 underwent CS during active labor and 255 at complete dilatation. The complete dilatation group exhibited significantly higher rates of uterine atony (19.6% vs. 11.6%, p = 0.009) and uterine incision extension (34.2% vs. 16.5%, p = 0.0001). In addition, they had longer hospital stays (4.8 vs. 4.25 days, p = 0.003) and higher outpatient clinic visit rates (21.3% vs. 9.9%, p = 0.0001). Infection-related complications on readmission were more common in the complete dilatation group (20% vs. 9.7%, p = 0.001). Neonatal outcomes, including APGAR scores and NICU admissions, did not differ significantly between the groups.
Emergent cesarean sections performed at complete cervical dilatation are associated with increased intra-operative and post-operative complications compared to those performed during active labor. These findings highlight the importance of considering the stage of labor when planning cesarean delivery to minimize risks and optimize outcomes for both mother and neonate.
比较活跃期第一产程和第二产程行急诊剖宫产术（CS）的近期和远期并发症。
我们对来自单一学术中心的电子病历进行了回顾性分析，纳入了577例宫颈扩张4厘米或以上时行急诊剖宫产术的患者数据。患者分为两组：第一产程（宫颈扩张4 - 9厘米）行剖宫产术的患者和宫颈完全扩张（10厘米）时行剖宫产术的患者。比较了母婴结局，包括子宫收缩乏力、产后出血、感染和新生儿重症监护病房（NICU）入院等并发症的发生率。
577例患者中，352例在活跃期行剖宫产术，255例在宫颈完全扩张时行剖宫产术。宫颈完全扩张组子宫收缩乏力发生率（19.6% 对11.6%，p = 0.009）和子宫切口延长发生率（34.2% 对16.5%，p = 0.0001）显著更高。此外，他们的住院时间更长（4.8天对4.25天，p = 0.003），门诊复诊率更高（21.3% 对9.9%，p = 0.0001）。再次入院时与感染相关的并发症在宫颈完全扩张组更常见（20% 对9.7%，p = 0.001）。两组间新生儿结局，包括阿氏评分和NICU入院情况，差异无统计学意义。
与活跃期行急诊剖宫产术相比，宫颈完全扩张时行急诊剖宫产术会增加术中及术后并发症。这些发现凸显了在计划剖宫产时考虑产程阶段的重要性，以尽量降低风险并优化母婴结局。
