Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health.
Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health.
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DOI：
10.1038/srep44093
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发表时间：
2017-03-10
影响因子：
4.6
通讯作者：
Mori R
中科院分区：
文献类型：
--
作者：
Motomura K;Ganchimeg T;Nagata C;Ota E;Vogel JP;Betran AP;Torloni MR;Jayaratne K;Jwa SC;Mittal S;Dy Recidoro Z;Matsumoto K;Fujieda M;Nafiou I;Yunis K;Qureshi Z;Souza JP;Mori R
剖腹产（CS）在全球范围内不断增加，既往有CS的女性在随后的妊娠中子宫破裂的风险更高。然而，对于有CS病史的妇女子宫破裂的发病率、危险因素和结局知之甚少，尤其是在发展中国家。为了调查这一点，我们对世界卫生组织的孕产妇和新生儿健康多国调查进行了二次分析，其中包括29个国家359个设施的分娩数据。在既往至少有一次CS的妇女中，子宫破裂的发生率为0.5%（170/37，366），范围从高人类发展指数（HDI）国家的0.2%到低HDI国家的1.0%。与子宫破裂显著相关的因素包括在中等或低人类发展指数国家分娩（调整后的比值比[AOR]分别为2.0和3.88），母亲受教育程度较低（≤6年）（AOR 1.71），自然分娩（AOR 1.62）和出生时胎龄<37周（AOR 3.52）。子宫破裂的妇女有显着较高的孕产妇死亡（AOR 4.45）和围产儿死亡（AOR 33.34）的风险。患有CS的女性，特别是在资源有限的情况下，面临子宫破裂和随后不良结局的风险更高。需要进一步研究这些环境中的预防/管理策略。
Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.