Risk factors for bladder injury during cesarean delivery
Risk factors for bladder injury during cesarean delivery
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DOI：
10.1097/01.aog.0000149150.93552.78
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发表时间：
2005-01-01
影响因子：
7.2
通讯作者：
Myers, DL
中科院分区：
文献类型：
--
作者：
Phipps, MG;Watabe, B;Myers, DL
目的：明确剖宫产中膀胱损伤的危险因素，以便患者和从业者了解这些危险因素。方法：对1995年1月至2002年12月在妇幼保健院剖宫产的产妇进行病例对照研究。病例为剖宫产时有膀胱损伤的妇女。每例随机抽取2名对照。结果：在14,757例剖宫产中发现42例膀胱损伤(发生率为0.28%)。既往剖腹产在患者中的发生率高于对照组(67%比32%，P<；.01)。调整后的风险为3.82(95%可信区间1.62-8.97)。在紧急分娩时间(31%比11%)、剖宫产前分娩(83%比61%)、剖宫产后尝试阴道分娩(%比22%)、并发子宫破裂(14%比0%)、粘连(60%比10%)、年龄(33.6岁比29.3岁)和体重指数(29.9比33.0 kg/m(2))方面，病例组和对照组之间的差异有统计学意义(P<0.01)。子宫切开类型、引产方式、绒毛膜羊膜炎、胎位、胎龄、母体疾病之间无明显差异。结论：剖宫产是再次剖宫产时膀胱损伤的危险因素。应该对患者进行关于这种风险的咨询，特别是在选择性初次剖宫产率增加的情况下。《妇科杂志》2005；105：156-60。(C)2005年，由美国妇产科医师学会提供。
OBJECTIVE: To identify risk factors for bladder injury during cesarean delivery so as to inform patients and practitioners of these risks.METHODS: We conducted a case-control study of women undergoing cesarean delivery at Women and Infants Hospital between January 1995 and December 2002. Cases were women with bladder injuries at the time of cesarean delivery. Two controls per case were selected randomly. Medical records were reviewed for demographic and clinical data to compare cases and controls.RESULTS: Forty-two bladder injuries were identified among 14,757 cesarean deliveries (incidence of 0.28%). Prior cesarean delivery was more prevalent among cases than controls (67% versus 32%, P < .01). The adjusted risk for bladder injury associated with prior cesarean delivery was 3.82 (95% confidence interval 1.62-8.97). Statistically significant differences (P values < .01) between cases and controls were found in emergent timing of delivery (31% versus 11%), labor before cesarean (83% versus 61%), attempted vaginal birth after cesarean (64% versus 22%), concurrent uterine rupture (14% versus 0%), adhesions (60% versus 10%), age (33.6 versus 29.3 years), and body mass index (29.9 versus 33.0 kg/m(2)). No differences were found among type of uterine incision, labor induction, chorioamnionitis, fetal position, gestational age, or maternal illnesses.CONCLUSION: Prior cesarean delivery is a risk factor for bladder injury at the time of repeat cesarean delivery. Patients should be counseled regarding this risk, particularly in the setting of increasing rates of elective primary cesarean delivery. (Obstet Gynecol 2005;105:156-60. (C) 2005 by The American College of Obstetricians and Gynecologists.).