背景:剖宫产(CD)后开腹手术是一种罕见的并发症,在风险因素和发生迹象方面存在不一致。因此,我们旨在确定在单个大型三级中心进行CD后进行剖腹手术的风险因素和适应症。
方法:回顾性病例对照单中心研究(2013-2023年)。我们确定了所有在CD(研究组)后六周内进行了重新剖腹手术的妇女。产妇特征,以1:2的比例将产科和手术数据与对照组进行比较.对照组是研究组中每个病例之前和之后立即患有CD的女性,没有接受剖腹手术的人。包括妊娠24周后发生的CD。在不同中心进行的CD和与主要手术无关的重复手术的适应症(例如,阑尾炎)被排除。Logistic回归用于调整潜在的混杂因素。
结果:在研究期间,131268名妇女在我们的机构交付。其中,28,280(21.5%)拥有CD,130例患者(0.46%)接受了剖腹手术。在最初的24小时内发生了CD后的重新腹腔镜手术,第一周,在第一周之后,在59.2%,33.1%,和7.7%的病例,分别。在多变量逻辑回归分析中,再次开腹手术与苗勒氏畸形(aOR3.33,95CI1.08-10.24,p=0.036);子宫肌瘤(aOR3.17,95CI1.11-9.05,p=0.031);多胎妊娠(aOR4.1,95CI1.43-11.79,p=0.009);妊娠高血压疾病(aOR3.46,95CI1.29-9.3,p=在第二次妊娠期间使用期间使用1.54止血剂,或手术引流)(aOR2.23,95CI1.29-4.12,p=0.012)。根据从CD开始经过的时间,重新剖腹手术的适应症有所不同,在最初的24小时内,可疑的腹腔内出血(36.1%)成为主要指征。
结论:我们检测到几个怀孕,产时,以及CD后需要进行剖腹手术的术中风险因素。从业者可以利用这些发现来主动识别处于危险中的女性,从而潜在地降低其相关的发病率。
BACKGROUND: Relaparotomy following a cesarean delivery (CD) is an infrequent complication, with inconsistency regarding risk factors and indications for its occurrence. We therefore aimed to determine risk factors and indications for a relaparotomy following a CD at a single large tertiary center.
METHODS: A retrospective case-control single-center study (2013-2023). We identified all women who had a relaparotomy up to six weeks following a CD (study group). Maternal characteristics, obstetrical and surgical data were compared to a control group in a 1:2 ratio. Controls were women with a CD before and immediately after each case in the study group, who did not undergo a relaparotomy. Included were CDs occurring after 24 gestational weeks. CD performed at different centers and indications for repeat surgery unrelated to the primary surgery (e.g., appendicitis) were excluded. Logistic regression was used to adjust for potential confounders.
RESULTS: During the study period, 131,268 women delivered at our institution. Of them, 28,280 (21.5%) had a CD, and 130 patients (0.46%) underwent a relaparotomy. Relaparotomies following a CD occurred during the first 24 h, the first week, and beyond the first week, in 59.2%, 33.1%, and 7.7% of cases, respectively. In the multivariable logistic regression analysis, relaparotomy was significantly associated with Mullerian anomalies (aOR 3.33, 95%CI 1.08-10.24, p = 0.036); uterine fibroids (aOR 3.17, 95%CI 1.11-9.05,p = 0.031); multiple pregnancy (aOR 4.1, 95%CI 1.43-11.79,p = 0.009); hypertensive disorders of pregnancy (aOR 3.46, 95%CI 1.29-9.3,p = 0.014); CD during the second stage of labor (aOR 2.54, 95%CI 1.15-5.88, p = 0.029); complications during CD (aOR 1.62, 95%CI 1.09-3.21,p = 0.045); and excessive bleeding during CD or implementation of bleeding control measures (use of tranexamic acid, a hemostatic agent, or a surgical drain) (aOR 2.23, 95%CI 1.29-4.12,p = 0.012). Indications for relaparotomy differed depending on the time elapsed from the CD, with suspected intra-abdominal bleeding (36.1%) emerging as the primary indication within the initial 24 h.
CONCLUSIONS: We detected several pregnancy, intrapartum, and intra-operative risk factors for the need for relaparotomy following a CD. Practitioners may utilize these findings to proactively identify women at risk, thereby potentially reducing their associated morbidity.