Logstein Erika, Torp Richard, Ashley Thomas, Kamara Michael M, Koroma Alimamy P, Dumbuya Abu Bakarr, Suma Musa S, Moijue Abdul Rahman, Westendorp Josien, Kujabi Monica L, Rijken Marcus J, Wibe Arne, Hagander Lars, Leather Andrew J M, Bolkan Håkon A, van Duinen Alex J
Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
CapaCare, Masanga Hospital, Tonkolili, Sierra Leone.
Int J Gynaecol Obstet. 2025 Mar;168(3):1210-1220. doi: 10.1002/ijgo.15996. Epub 2024 Nov 2.
Cesarean section (CS) is a life-saving procedure when performed for the right indication but carries substantial risks, specifically during subsequent pregnancies. The aim of this study was to evaluate obstetric outcomes for women 5 years after a CS performed by medical doctors and associate clinicians. This was a prospective multi-center observational study of women who had a CS at any of nine hospitals in Sierra Leone. Women and their offspring were followed up with three home visits for 5 years after surgery. Outcomes of interest included long-term complications, mode and place of delivery, and maternal and pediatric outcomes of subsequent pregnancies. Of the 1274 women included in the study, 140 (11.0%) were lost to follow-up. Within 5 years after the index CS, 27.0% of the women became pregnant and 2.5% had a second pregnancy. Women with perinatal death at the index CS had 5.25 higher odds of becoming pregnant within 1 year. Of the 259 women who delivered, 31 (12.0%) had a planned CS and 228 (88.0%) attempted a trial of labor after CS, resulting in either a successful vaginal birth (n = 138; 60.5%) or an emergency CS (n = 90; 39.5%). Peripartum and long-term complications did not significantly differ between those that were operated on by medical doctors and associate clinicians. Within 5 years after CS, one in four women became pregnant again and more than half had a vaginal delivery. Significant differences in place and mode of birth between wealth quintiles illustrate inequities.
剖宫产（CS）在有正确指征时是一种挽救生命的手术，但存在重大风险，尤其是在后续妊娠期间。本研究的目的是评估由医生和助理临床医生实施剖宫产术后5年的女性的产科结局。这是一项对在塞拉利昂九家医院中的任何一家进行剖宫产的女性进行的前瞻性多中心观察性研究。女性及其后代在术后5年接受了三次家访随访。感兴趣的结局包括长期并发症、分娩方式和地点，以及后续妊娠的母婴结局。在纳入研究的1274名女性中，140名（11.0%）失访。在首次剖宫产术后5年内，27.0%的女性怀孕，2.5%的女性再次怀孕。首次剖宫产时发生围产期死亡的女性在1年内怀孕的几率高5.25倍。在259名分娩的女性中，31名（12.0%）进行了计划剖宫产，228名（88.0%）尝试了剖宫产术后试产，结果是成功阴道分娩（n = 138；60.5%）或急诊剖宫产（n = 90；39.5%）。医生和助理临床医生实施手术的患者在围产期和长期并发症方面没有显著差异。剖宫产术后5年内，四分之一的女性再次怀孕，超过一半的女性进行了阴道分娩。财富五分位数之间在分娩地点和方式上的显著差异说明了不平等现象。
