Maternal morbidity after caesarean section in developing countries: long term follow-up of a large factorial trial

剖腹产是世界上最常见的手术之一，然而，尽管剖腹产手术的数量和这种手术对妇女的短期和长期健康的影响，我们对剖腹产手术的哪种方法与并发症风险最低知之甚少。CORONIS试验将比较15000名妇女剖宫产时使用的外科手术的五个方面，以确定这些方面中哪一个与并发症风险最低有关。要比较的五对手术是：(a)两种不同的打开腹壁的方法(?钝？与锋利?);(b)子宫上的切口是在子宫保留在妇女骨盆内时进行修复还是在子宫外进行修复（子宫切口的腹外修复与腹内修复）；(c)子宫上的切口是用一层还是两层缝合（子宫的单层缝合还是双层缝合）；(d)腹膜（一种覆盖腹部所有器官的薄膜，使它们容易相互滑动）是否闭合（盆腔和腹膜壁闭合与不闭合）；(e)应使用两种不同类型的缝合材料中的哪一种缝合子宫（用于缝合子宫和直肌鞘的薇基缝合和肠线缝合）。这项随访研究将使我们能够评估原始手术后3年使用不同技术的后果。

Caesarean section is one of the commonest operations undertaken worldwide and yet despite the number of caesarean sections being performed and the impact of this operation on the short and long term health of women, we know very little about which approaches to doing the caesarean section are associated with the lowest risk of complications. The CORONIS trial will compare five aspects of the surgical procedures used at the time of caesarean section in 15,000 women to see which of these aspects is associated with the lowest risk of complications. The five pairs of procedures to be compared are: (a) two different approaches to opening the abdominal wall (?blunt? versus ?sharp?); (b) whether the cut on the womb is repaired while the womb is kept inside the womans pelvis or whether it is repaired outside (extra-abdominal versus intra-abdominal repair of the uterine incision); (c) whether the cut on the womb is closed in one layer of stitches or two (single versus double layer closure of the uterus); (d) whether the peritoneum, which is a thin membrane which covers all the organs inside the abdomen, letting them slide over each other easily, (closure versus non-closure of the pelvic and parietal peritoneum); (e) which of two different types of stitch material should be used for closing the womb (Vicryl versus catgut sutures for closure of the uterus and rectus sheath). This follow-up study will allow us to assess the consequences of the different techniques used at 3 years after the original operation.