子宫破裂的风险和结果在妇女有和没有试产。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2025-01-01 DOI:10.1016/j.jogc.2024.102718

Ohad Houri MD , Or Bercovich MD , Avital Wertheimer MD , Alexandra Berezowsky MD , Gil Zeevi MD , Shir Danieli-Gruber MD , Eran Hadar MD

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引用次数: 0

摘要

目的：本研究旨在评估子宫破裂患者的产妇和新生儿结局，比较那些进行了分娩试验的患者和那些没有进行分娩试验的患者。方法：2008 - 2019年在某高等院校医学中心进行人群回顾性研究。该队列包括所有在剖宫产（CD）或剖腹手术中被诊断为子宫破裂的妇女。曾经有过一次乳糜泻并经历过分娩试验的患者（TOLAC组）与有乳糜泻病史但没有分娩试验的患者和/或没有乳糜泻但在分娩过程中或分娩后诊断出子宫破裂的患者（no-TOLAC组）进行比较。排除子宫瘢痕裂开患者。结果：在研究期间分娩的103 542名妇女中，10 325名有既往CD。95例发生子宫破裂：55例接受TOLAC(0.98%)， 40例（0.85%）未进行分娩试验。与TOLAC组相比，未尝试TOLAC的单一既往CD妇女亚组（n = 16）新生儿重症监护病房住院率更高（56.3%比21.7%,OR 4.15, 95% CI 1.3-13.3, P = 0.01）和不良综合产妇结局（输血、膀胱损伤和/或重症监护病房住院）（75%比30.9%,OR 6.7, 95% CI 1.8-23.8, P < 0.01）。所有组均无新生儿或产妇死亡。结论：尽管TOLAC患者子宫破裂的发生率较高，但如果子宫破裂发生在分娩试验之外且子宫未损伤，则预后较差。

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Risks and Outcomes of Uterine Rupture in Women With and Without a Trial of Labour

Objectives

The study aimed to evaluate the maternal and neonatal outcomes in patients who experienced uterine rupture, comparing those who underwent a trial of labour to those who did not.

Methods

A population-based retrospective study was conducted in a tertiary university medical centre from 2008 to 2019. The cohort consisted of all women who were diagnosed with uterine rupture during cesarean delivery (CD) or laparotomy. Patients with 1 previous CD who underwent a trial of labour (TOLAC group) were compared against patients who had a history of CD in whom no trial of labour occurred, and/or against patients who had no prior CD in whom a ruptured uterus was diagnosed during or following delivery (no-TOLAC group). Patients with uterine scar dehiscence were excluded.

Results

Of 103 542 women who gave birth during the study period, 10 325 had a previous CD. Uterine rupture occurred in 95 cases: 55 among patients who had undergone TOLAC (0.98%) and 40 (0.85%) without trial of labour. Compared with the TOLAC group, the subgroup of women with a single prior CD who did not attempt TOLAC (n = 16) had a higher rate of neonatal intensive care unit admission (56.3% vs. 21.7%, OR 4.15; 95% CI 1.3–13.3, P = 0.01) and adverse composite maternal outcomes (blood transfusion, urinary bladder injury, and/or intensive care unit admission) (75% vs. 30.9%, OR 6.7; 95% CI 1.8–23.8, P < 0.01). There was no neonatal or maternal death in any group.

Conclusions

Despite the higher incidence of uterine rupture in women undergoing TOLAC, outcomes are less favourable when rupture occurs outside the trial of labour and if the uterus is unscarred.

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.