Emergent cesarean section during active labor-does cervical dilatation matter?

IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Gil Shechter Maor, Ziv Shapira, Chen Manor Bar, Shiran Sara Moore, Yael Yagur, Tal Biron-Shental, Omer Weitzner
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Abstract

Purpose: To compare the immediate and late complications associated with emergent cesarean sections (CS) performed during the first and second stages of active labor.

Methods: 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.

Results: 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.

Conclusion: 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.

活跃产程中的紧急剖宫产--宫颈扩张重要吗?
目的:比较在活跃产程第一和第二阶段实施紧急剖宫产术(CS)的近期和后期并发症:我们对一家学术中心的电子病历进行了回顾性分析,其中包括 577 名在宫颈扩张 4 厘米或以上时接受紧急剖宫产术的患者的数据。患者被分为两组:在第一产程(宫颈扩张 4-9 厘米)时进行剖宫产的患者和在宫颈完全扩张(10 厘米)时进行剖宫产的患者。对产妇和新生儿的结局进行了比较,包括并发症的发生率,如子宫失弛缓、产后出血、感染和新生儿重症监护室(NICU)入院率:在577名患者中,352人在活跃产程中进行了CS,255人在宫口完全扩张时进行了CS。完全宫口扩张组的子宫失弛缓率(19.6% 对 11.6%,P = 0.009)和子宫切口扩展率(34.2% 对 16.5%,P = 0.0001)明显高于完全宫口扩张组。此外,他们的住院时间更长(4.8 天 vs. 4.25 天,p = 0.003),门诊就诊率更高(21.3% vs. 9.9%,p = 0.0001)。完全扩张组再次入院时感染相关并发症更常见(20% 对 9.7%,P = 0.001)。新生儿预后,包括APGAR评分和新生儿重症监护室入院率,在两组之间没有显著差异:结论:与在活跃产程中进行的剖宫产手术相比,在宫颈完全扩张时进行的紧急剖宫产手术会增加术中和术后并发症。这些发现强调了在计划剖宫产时考虑产程的重要性,以最大限度地降低风险,优化母亲和新生儿的预后。
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来源期刊
CiteScore
4.70
自引率
15.40%
发文量
493
审稿时长
1 months
期刊介绍: Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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