Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania

Autor: Rob Mooij, Jelle Stekelenburg, Ipyana H. Mwampagatwa, J. van Dillen
Přispěvatelé: Public Health Research (PHR)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
medicine.medical_specialty
IMPACT
medicine.medical_treatment
Hospitals
Rural
Reproductive medicine
Adhesion (medicine)
Tissue Adhesions
lcsh:Gynecology and obstetrics
Tanzania
Trial of labour
03 medical and health sciences
DELIVERY
Young Adult
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
Pregnancy
medicine
Humans
Caesarean section
VAGINAL BIRTH
030212 general & internal medicine
Cesarean Section
Repeat
LABOR
lcsh:RG1-991
Outcome
Retrospective Studies
030219 obstetrics & reproductive medicine
biology
Obstetrics
business.industry
Medical record
Incidence (epidemiology)
Other Research Radboud Institute for Health Sciences [Radboudumc 0]
SAFETY CONCERNS
Obstetrics and Gynecology
Retrospective cohort study
biology.organism_classification
medicine.disease
Trial of Labor
FACTORIAL
Cross-Sectional Studies
TRIAL
Female
business
Research Article
Zdroj: BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth, 20(1):582. BMC
BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-6 (2020)
BMC Pregnancy and Childbirth, 20
BMC Pregnancy and Childbirth, 20, 1
ISSN: 1471-2393
Popis: Background The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. Methods A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. Results Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). Conclusions Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.
Databáze: OpenAIRE
Externí odkaz: