Abstract
Objective: Caesarean section in case of cicatricial uterus generates a real epidemiological and prognostic obstetric problem. It is a real concern for the obstetrician with regard to all the factors that can influence the maternal and perinatal prognosis. The aim of this study is to analyze indications for caesarean section in cases of uterine scarring and to establish maternal and neonatal pronotics at the University Hospital of Brazzaville. Methods: A cross-sectional analytical study conducted from January 1, 2015 to June 30, 2017 at the University Hospital of Brazzaville in Congo, comparing 150 deliveries by caesarean to 300 by vaginal route. Results: one hundred and fifty cesarized were recorded among 1212 women giving birth with scar uterus (12.3%). They were different from vaginal deliveries with uterine scarring in age (31 vs 28 years, p <0.05) and mostly referred (70% vs 20.7%, p <0.05). Caesareans were performed more urgently (52.7%) than prophylactically (47.3%). The risk of being caesarized was higher in the case of multiple scar (OR = 9.8 [4.5-21.1]), less than 16 months (OR = 10.2 [2.2-47.6]), and without evidence of strength in connection with a previous vaginal delivery (OR = 4.5 [1.7-11.8]). Emergency caesarean were dominated by acute fetal asphyxia (OR = 7.3 [3.6-14.5]) and dynamic dystocia (OR = 13.3 [10.1-26.6]). Maternal morbidity in cesarized patients was related to parietal suppuration (14, 9.3%) and was associated with a low risk of endometritis (3.4% vs 12%, OR = 0.2 [0.1-0.6], p <0.05). Newborns born to caesarean mothers were more resuscitated (17.2% vs 4%, OR = 4.9 [2.4-10.2], p <0.05), transferred to neonatology (19.8% vs 7.6%, OR = 2.9 [1.6-5.3 p <0.05) and died in the neonatal period (2.6% vs 0.3%, OR = 8.1 [1.2-52], p <0.05]. Conclusion: Caesarean section indications for cicatricial uterus are dominated by obstetric emergencies involving maternal and neonatal prognosis.
Highlights
The uterus is scarred when it carries one or more anterior myometrial lesions in any part of the body or isthmus [1].Cesarean delivery increases the probability of a new caesarean section by 8 to 10 because of the risk of uterine rupture associated with the fragility of the uterus [2]
In addition to the scar, delivery in case of scar uteri depends on Journal of Gynecology and Obstetrics 2019; 7(2): 56-59 obstetric conditions and maternal and fetal status [1, 3]
The objective pursued by the present study was to analyze the indications for caesarean and the maternal and neonatal prognosis for scarred uterus at the University Hospital of Brazzaville
Summary
The uterus is scarred when it carries one or more anterior myometrial lesions in any part of the body or isthmus [1]. Cesarean delivery increases the probability of a new caesarean section by 8 to 10 because of the risk of uterine rupture associated with the fragility of the uterus [2]. In addition to the scar, delivery in case of scar uteri depends on Journal of Gynecology and Obstetrics 2019; 7(2): 56-59 obstetric conditions and maternal and fetal status [1, 3].
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