Re-exploration following caesarean birth: a prospective national case–control study using the United Kingdom Obstetric Surveillance System (UKOSS) data collection system

IF 7.5 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia Pub Date : 2024-07-31 DOI:10.1111/anae.16392

Kailash Bhatia, Malachy Columb, Marian Knight, Sarah Vause

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引用次数: 0

Abstract

Background

Re-exploration following caesarean birth and the associated maternal morbidity has not been investigated in the UK. Our aims were to determine the national incidence and identify the associated risk factors.

Methods

We conducted a prospective observational case–control study across 194 UK consultant-led maternity units in women whose caesarean birth was complicated by a re-exploration. Independent factors for re-exploration were analysed using multivariable multi-level mixed effects logistic regression.

Results

Over the study period (1 June 2021 and 31 May 2022) 238,423 caesarean births were recorded across the UK of which 187 women underwent re-exploration, giving an incidence of one re-exploration per 1282 caesarean births (95%CI 1:1099–1:1471). Haemorrhage (124/187, 66.3%) and sepsis (31/187, 16.6%) were the most common findings at re-exploration. Median (IQR [range]) time interval to re-exploration following the caesarean birth was 1 (0–4 [0–28]) day. Mechanical ventilation was required in 34 (18.6%) women, cardiac arrest was reported in 5 (2.7%) and 3 (1.6%) women died. Independent preceding factors associated with a re-exploration included: receipt of blood transfusion (adjusted OR (95%CI) 8.25 (2.66–25.61)); use of a general anaesthetic (adjusted OR (95%CI) 3.33 (1.61–6.88)); pre-eclampsia (adjusted OR (95%CI) 3.27 (1.55–6.91)); black ethnicity (adjusted OR (95%CI) 3.14 (1.39–7.11)); postpartum haemorrhage (adjusted OR (95%CI) 2.82 (1.81–4.37)); use of anticoagulants or antiplatelet drugs pre-caesarean birth (adjusted OR (95%CI) 2.26 (1.35–3.81)); and emergency caesarean birth (adjusted OR (95%CI) 1.89 (1.01–3.57)).

Conclusion

Re-exploration following caesarean birth in the UK is uncommon but is associated with significant maternal morbidity and mortality. These study findings will help guide informed consent and encourage appropriate surveillance of high-risk women postpartum.

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剖腹产后再次剖腹产：利用英国产科监测系统（UKOSS）数据收集系统进行的前瞻性全国病例对照研究。

背景：英国尚未对剖腹产后再次剖腹产及其相关的产妇发病率进行调查。我们的目的是确定全国的发生率并找出相关的风险因素：我们对英国 194 家由咨询师主导的产科医院进行了一项前瞻性病例对照观察研究，研究对象是剖腹产并发再次剖腹产的产妇。采用多变量多级混合效应逻辑回归分析了再次剖腹产的独立因素：在研究期间（2021 年 6 月 1 日至 2022 年 5 月 31 日），英国共记录了 238423 例剖腹产，其中 187 名产妇接受了再次剖腹产，即每 1282 例剖腹产中有 1 例再次剖腹产（95%CI 1:1099-1:1471）。大出血（124/187，66.3%）和败血症（31/187，16.6%）是再次剖腹产最常见的结果。剖腹产后再次剖腹产的时间间隔中位数（IQR [范围]）为 1（0-4 [0-28]）天。34名产妇（18.6%）需要机械通气，5名产妇（2.7%）心脏骤停，3名产妇（1.6%）死亡。与再次剖宫产相关的独立先决因素包括：接受输血（调整后 OR (95%CI) 8.25 (2.66-25.61)）；使用全身麻醉（调整后 OR (95%CI) 3.33 (1.61-6.88)）；子痫前期（调整后 OR (95%CI) 3.27 (1.55-6.91)）；黑人（调整后 OR (95%CI) 3.14（1.39-7.11））；产后出血（调整OR（95%CI）2.82（1.81-4.37））；剖宫产前使用抗凝剂或抗血小板药物（调整OR（95%CI）2.26（1.35-3.81））；以及紧急剖宫产（调整OR（95%CI）1.89（1.01-3.57））：结论：在英国，剖腹产后再次剖腹产的情况并不常见，但却与孕产妇的发病率和死亡率密切相关。这些研究结果将有助于为知情同意提供指导，并鼓励对产后高风险妇女进行适当的监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anaesthesia 医学-麻醉学

CiteScore

21.20

自引率

9.30%

发文量

300

审稿时长

6 months

期刊介绍： The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.