Caesarean in Case of Scar Uterus: Indications and Maternal and Neonatal Prognosis at the University Hospital of Brazzaville (Republic of Congo)

Supplement to International journal of gynecology and obstetrics Pub Date : 2019-05-20 DOI:10.11648/J.JGO.20190702.16

Itoua Clautaire, Iloki Itoba Imongui Sandra, Buambo Gauthier Régis Jostin, Potokoue Mpia Samantha Nuelly, Mokoko Jules César, Ngakengni Nelie Yvette, Eouani Max Lévy Eméry, Iloki Léon Hervé

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Abstract

Objective: Caesarean section in case of cicatricial uterus generates a real epidemiological and prognostic obstetric problem. It is a real concern for the obstetrician with regard to all the factors that can influence the maternal and perinatal prognosis. The aim of this study is to analyze indications for caesarean section in cases of uterine scarring and to establish maternal and neonatal pronotics at the University Hospital of Brazzaville. Methods: A cross-sectional analytical study conducted from January 1, 2015 to June 30, 2017 at the University Hospital of Brazzaville in Congo, comparing 150 deliveries by caesarean to 300 by vaginal route. Results: one hundred and fifty cesarized were recorded among 1212 women giving birth with scar uterus (12.3%). They were different from vaginal deliveries with uterine scarring in age (31 vs 28 years, p <0.05) and mostly referred (70% vs 20.7%, p <0.05). Caesareans were performed more urgently (52.7%) than prophylactically (47.3%). The risk of being caesarized was higher in the case of multiple scar (OR = 9.8 [4.5-21.1]), less than 16 months (OR = 10.2 [2.2-47.6]), and without evidence of strength in connection with a previous vaginal delivery (OR = 4.5 [1.7-11.8]). Emergency caesarean were dominated by acute fetal asphyxia (OR = 7.3 [3.6-14.5]) and dynamic dystocia (OR = 13.3 [10.1-26.6]). Maternal morbidity in cesarized patients was related to parietal suppuration (14, 9.3%) and was associated with a low risk of endometritis (3.4% vs 12%, OR = 0.2 [0.1-0.6], p <0.05). Newborns born to caesarean mothers were more resuscitated (17.2% vs 4%, OR = 4.9 [2.4-10.2], p <0.05), transferred to neonatology (19.8% vs 7.6%, OR = 2.9 [1.6-5.3 p <0.05) and died in the neonatal period (2.6% vs 0.3%, OR = 8.1 [1.2-52], p <0.05]. Conclusion: Caesarean section indications for cicatricial uterus are dominated by obstetric emergencies involving maternal and neonatal prognosis.

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疤痕子宫的剖宫产:布拉柴维尔大学医院(刚果共和国)的适应症和母婴预后

目的:瘢痕性子宫剖宫产术产生了一个真正的流行病学和预后产科问题。对于产科医生来说，考虑到所有可能影响产妇和围产期预后的因素，这是一个真正值得关注的问题。本研究的目的是分析子宫瘢痕病例剖宫产的指征，并在布拉柴维尔大学医院建立产妇和新生儿促生症。方法:2015年1月1日至2017年6月30日在刚果布拉柴维尔大学医院进行了一项横断面分析研究，比较了150例剖腹产分娩和300例阴道分娩。结果:1212例瘢痕子宫分娩妇女中有150例(12.3%)剖宫产。在年龄(31岁vs 28岁，p <0.05)上与阴道分娩有瘢痕形成者有差异，且多数为转诊(70% vs 20.7%， p <0.05)。紧急剖腹产(52.7%)多于预防性剖腹产(47.3%)。多发瘢痕(OR = 9.8[4.5-21.1])、小于16个月(OR = 10.2[2.2-47.6])、没有阴道分娩相关力量的证据(OR = 4.5[1.7-11.8])，剖腹产的风险更高。急诊剖宫产以急性胎儿窒息(OR = 7.3[3.6-14.5])和动态难产(OR = 13.3[10.1-26.6])为主。剖宫产患者的产妇发病率与子宫内膜化脓有关(14.9.3%)，与子宫内膜炎的低风险相关(3.4% vs 12%， OR = 0.2 [0.1-0.6]， p <0.05)。剖宫产母亲所生新生儿复苏率(17.2% vs 4%， OR = 4.9 [2.4 ~ 10.2]， p <0.05)、转至新生儿科(19.8% vs 7.6%， OR = 2.9 [1.6 ~ 5.3 p <0.05])和新生儿期死亡率(2.6% vs 0.3%， OR = 8.1 [1.2 ~ 52]， p <0.05)较高。结论:瘢痕子宫剖宫产指征以产科急诊为主，涉及孕产妇和新生儿预后。

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Supplement to International journal of gynecology and obstetrics

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