Boyle J G, Gabbe S G
Division of Maternal-Fetal Medicine, Ohio State University Medical Center, Columbus, USA.
Obstet Gynecol. 1996 Feb;87(2):238-43. doi: 10.1016/0029-7844(95)00388-6.
To determine the frequency of T and J extensions in low transverse cesarean births at a regional perinatal center, identify the indications for these incisions, and evaluate the associated complications.
We reviewed the medical records of 56 patients delivered between January 1988 and November 1994 by low transverse cesarean birth requiring vertical extension of the incision into-the upper uterine segment. Cases of extension were compared with controls matched for gestational age, presentation, and indication for cesarean delivery. Data collected included demographic information, indications for extension, extension type, estimated blood loss, intraoperative complications, and length of hospital stay. Paired Student t test and McNemar test were used for statistical analysis.
Vertical extensions were performed in 1.3% (95% confidence interval 0.42-2.26%) of low transverse incisions over a 7-year period. The most common indications were malpresentation (n = 31), poorly developed lower uterine segment (n = 12), and fetal head deeply arrested in the midpelvis (n = 6). Estimated blood loss was greater for patients requiring an extension (990 +/- 310 mL) compared with controls (790 +/- 150 mL), as were differences in preoperative versus postoperative hemoglobin and hematocrit (P < .05). Surgical complications were observed in 28 of 56 (50%) subjects with a uterine extension, including excessive blood loss (n = 20), broad ligament hematomas or extensions (n = 4), cervical lacerations (n = 4), and uterine artery lacerations (n = 4). Patients with vertical extensions also had longer hospital stays (4.6 +/- 1.6 versus 3.8 +/- 1.1 days) (P < .05).
Low transverse uterine incisions may be inadequate for the safe delivery of a fetus in cases of malpresentation, preterm birth, and poor development of the lower uterine segment. Used to complete these difficult deliveries, T and J extensions are often associated with intraoperative complications and prolonged hospital stays compared with controls.
确定某地区围产期中心低位横切口剖宫产术中T形和J形延长切口的发生率，明确这些切口的指征，并评估相关并发症。
我们回顾了1988年1月至1994年11月间56例低位横切口剖宫产分娩患者的病历，这些患者需要将切口垂直延长至子宫上段。将切口延长的病例与孕周、胎位和剖宫产指征相匹配的对照组进行比较。收集的数据包括人口统计学信息、延长指征、延长类型、估计失血量、术中并发症和住院时间。采用配对t检验和McNemar检验进行统计分析。
在7年期间，1.3%（95%置信区间0.42 - 2.26%）的低位横切口进行了垂直延长。最常见的指征是胎位异常（n = 31）、子宫下段发育不良（n = 12）和胎头深嵌于中骨盆（n = 6）。与对照组（790 ± 150 mL）相比，需要延长切口的患者估计失血量更大（990 ± 310 mL），术前与术后血红蛋白和血细胞比容的差异也更大（P < 0.05）。56例子宫切口延长的患者中有28例（50%）出现手术并发症，包括失血过多（n = 20）、阔韧带血肿或延伸（n = 4）、宫颈裂伤（n = 4）和子宫动脉裂伤（n = 4）。垂直延长切口的患者住院时间也更长（4.6 ± 1.6天对3.8 ± 1.1天）（P < 0.05）。
对于胎位异常、早产和子宫下段发育不良的情况，低位横切口子宫剖宫产可能不足以安全娩出胎儿。用于完成这些困难分娩的T形和J形延长切口与对照组相比，常伴有术中并发症和住院时间延长。
