Саратовский научно-медицинский ЖУРНАЛ

Периоперационные и отдаленные осложнения при кесаревом сечении: систематический обзор

Резюме:

Цель: на основании литературных данных проанализировать осложнения кесарева сечения (КС) и связанную с ними материнскую и перинатальную смертность с учетом экономического развития страны, показаний к выполнению вмешательства, экстренности, методов операции и анестезии, профилактических мер. Проведен поиск в электронных базах данных исследований, касающихся материнской или перинатальной заболеваемости и смертности, связанных с КС. В анализ вошли 167 исследований, представивших 5100161 операцию КС и 8216 случаев материнской смертности, соответствующих критериям включения. Рассчитывали показатели распространенности осложнений, связанных с КС, отношения шансов (ОШ) и относительный риск (ОР) с 95%-м доверительным интервалом (ДИ). Риск смерти женщин в странах с низким и средним уровнем дохода, перенесших КС, составил 7,6 случая на 1000 [95% ДИ: 6,6-8,6]; в высокоразвитых странах 0,6 на 1000 [95% ДИ: 0,08-0,9]. В странах с низким уровнем дохода перинатальная смертность составила 84,7 случая на 1000 КС [95% ДИ: 70,5-100,2]; в странах с высоким уровнем дохода 12,7 на 1000 КС [95% ДИ: 6,85-18,3]. Наиболее частыми периоперационными осложнениями при КС являлись: кровотечения (ОШ=0,52 [95% ДИ: 0,48-0,57]), инфекция (ОШ=13,4 [95% ДИ: 9,7-22,3]) и венозный тромбоэмболизм (ОШ=1,4 [95% ДИ: 1,2-3,5]). Таким образом, страны с низким уровнем дохода имеют высокую материнскую смертность и требуют оптимизации условий для проведения КС. Значительное увеличение частоты КС в странах с высоким уровнем доходов не привело к соответствующему снижению неонатальной заболеваемости и смертности, однако увеличило риск для здоровья и жизни женщины.

Литература:
1. Mascarello КС, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Rev Saude Publica 2017; 51: 105.
2. Souza JP, Gulmezoglu A, Lumbiganon P, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. 71 ВМС Med 2010; 8.
3. Betran AP, Ye J, Moller AB, et al. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE 2016; 11 (2): e0148343.
4. Hallgrimsdottir H, Shumka L, Althaus C, et al. Fear, Risk and the Responsible Choice: Risk Narratives and Lowering the Rate of Caesarean Sections in High-income Countries. AIMS Public Health 2017; 4 (6): 615-32.
5. Irani M, Deering S. Challenges affecting access to cesarean delivery and strategies to overcome them in low-income countries. Int J Gynaecol Obstet 2015; 131 (1): 30-4.
6. Cantwell R, Clutton-Brock T, Cooper G, et al. Centre for Maternal and Child Enquiries (CMACE): Reviewing maternal deaths to make motherhood safer: The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG2011; 118 (Suppl 1): 1-203.
7. Pallasmaa N, Ekbald U. Cesarean delivery in Finland: maternal complications and obstetric risk factors. Acta Obstet Gynecol Scand 2010; (89): 896-902.
8. Ghaffari S, Dehghanpisheh L, Tavakkoli F, et al. The Effect of Spinal versus General Anesthesia on Quality of Life in Women Undergoing Cesarean Delivery on Maternal Request. 2018; Cureus10(12):e3715.
9. Sobhy S, Zamora J, Dharmarajah K, et al. Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2016; 4 (5): 320-7.
10. Burton-Jeangros С Surveillance of risks in everyday life: The agency of pregnant women and its limitations. Soc Theory Health 2011; 9: 419-36.
11. Scamell M. The fear factor of risk-clinical governance and midwifery talk and practice in the UK. Midwifery 2016; 38: 14-20.
12. ButwickAJ, Carvalho B, Blumenfeld YJ, etal. Second-line uterotonics and the risk of hemorrhage-related morbidity. Am J Obstet Gynecol 2015; 212: 642: e641-7.
13. Butwick AJ, Ramachandran B, Hegde P, et al. Risk factors for severe postpartum hemorrhage after cesarean delivery: case-control studies. Anesth Analg 2017; 125 (2): 523-32.
14. Knight M, Callaghan WM, Berg C, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the international postpartum hemorrhage collaborative group. ВМС Pregnancy Childbirth 2009; 9:55.
15. Briley A, Seed PT, Tydeman G, et al. Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe pph: a prospective observational study. BJOG2014; 121 (7): 876-88.
16. Callaghan WM, Mackay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, united states, 1991-2003. Am J Obstet Gynecol 2008; 199 (2): 133. e1-8.
17. Farchi S, Polo A, Franco F, et al. Severe postpartum morbidity and mode of delivery: a retrospective cohort study. Acta Obstet Gynecol Scand 2010; 89 (12): 1600-3.
18. Shaylor R, Weiniger CF, Austin N, et al. National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review Anesth Analg 2016; 124: 216-32.
19. Looft E, Simic M, Ahlberg M, et al. Duration of second stage of labour at term and pushing time: Risk factors for postpartum haemorrhage. Paediatr Perinat Epidemiol 2017; 31: 126-33.
20. Miller CM, Cohn S, Akdagli S, et al. Postpartum hemorrhage following vaginal delivery: risk factors and maternal outcomes. J Perinatal 2017; 37: 243-8.
21. Weeks AD, Neilson JP. Rethinking our approach to postpartum haemorrhage and uterotonics. BMJ. 2015; 351: h3251.
22. Clyburn P, Collins R, Harries S. General anaesthesia. Obstetric Anaesthesia for Developing Countries. Oxford University Press, Oxford, UK, 2010.
23. Sobhy S, Thangaratinam S, Zamora J, et al. Anaesthesia related maternal and perinatal mortality and morbidity in developing countries: a systematic review and meta-analysis. Prospero 2015; CRD42015015805.
24. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2012; 10 (CD004350).
25. Goto M, Yoshizato T, Tatsumura M, et al. Safety and efficacy of thromboprophylaxis using enoxaparin sodium after cesarean section: A multi-center study in Japan. Taiwan J Obstet Gynecol 2015; 54 (3): 248-52.
26. Farjah A, Hessa AD, Saud AH, et al. C0327 Thromboembolism prophylaxis after cesarean section (PRO-CS) trial. Thrombosis Research 2012; 130: S197-S197.
27. JacobsenAF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium-a register-based case-control study. Am J Obstet Gynecol 2008; 198: 233. e1-7.
28. Sia WW, Powrie RO, Cooper AB, et al. The incidence of deep vein thrombosis in women undergoing cesarean delivery. Thrombosis Research 2009; 123 (3): 550-5.
29. Sun J, Ding M, Liu J, et al. Prophylactic administration of cefazolin prior to skin incision versus antibiotics at cord clamping in preventing post-cesarean infectious morbidity: a systematic review and meta-analysis of randomized controlled trials. Gynecol Obstet Investig 2013; 75 (3): 175-8.
30. WHO. Education Material for Teachers of Midwifery: Midwifery Education Modules — Second Edition, In Managing Puerperal Sepsis. WHO Press: Geneva; 2008.
31. Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 2017; 30: 8-12.
32. Conroy K, Koenig AF, Yu YH, et al. Infectious morbidity after cesarean delivery: 10 strategies to reduce risk. Reviews in obstetrics & gynecology 2012; 5: 69-77.
33. Menderes G, Athar AN N, Aagaard K, et al. Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis in cesarean deliveries. Obstet Gynecol 2012; 120: 1037-44.
34. Baaqeel H, Baaqeel R. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis. BJOG: an international journal of obstetrics and gynaecology 2013; 120: 661-9.
35. Tita AT, Szychowski JM, Boggess K, et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. The New England journal of medicine 2016; 375: 1231-41.
36. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018; 15 (1): e1002494.
37. Gyhagen M, Bullarbo M, Nielsen TF, et al. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2013; 120 (2): 152-60.
38. Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial. Am J Obstet Gynecol 2004; 191 (3): 917-27.
39. MacArthur C, Glazener C, Lancashire R, et al. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG 2011; 118(8): 1001-7.
40. Woolhouse H, Perlen S, Gartland D, et al. Physical Health and Recovery in the First 18 Months Postpartum: Does Cesarean Section Reduce Long-Term Morbidity? BIRTH 2012; 39(3): 221-9.
41. McDonald EA, Gartland D, Small R, et al. Dyspareunia and Childbirth: A Prospective Cohort Study. Obstet Gynecol Surv 2015; 70 (5): 319-20.
42. Elvander C, Dahlberg J, Andersson G, et al. Mode of delivery and the probability of subsequent childbearing: a population-based register study. BJOG 2015; 122 (12): 1593-600.
43. Fussing-Clausen C, Geirsson RT, Hansen T, Rasmussen S, et al. Mode of delivery and subsequent reproductive patterns. A national follow-up study. Acta Obstet Gyn Scan 2014; 93 (10): 1034-41.
44. Maaloe N, Aabakke AJ, Secher NJ. Midline versus transverse incision for cesarean delivery in low-income countries. Int J Gynaecol Obstet 2014; 125 (1): 1 -2.
45. World Health Organization, UNFPA, UNICEF, World Bank. Integrated Management of Pregnancy and Childbirth. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. URL: http://whqlibdoc.who.int/publication s/2007/9241545879_eng. pdf. Published 2000. Upadated 2007. Accessed August 23, 2013.
46. Jackson S, Fleege L, Fridman M, et al. Morbidity following primary cesarean delivery in the Danish National Birth Cohort. Am J Obstet Gynecol 2012; 206 (2): 139e1-5.
47. Black M, Bhattacharya S, Philip S, Norman JE, McLernon DJ. Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health. JAMA 2015; 314 (21): 2271 -9.
48. Van Berkel AC, den Dekker HT, Jaddoe VWV, et al. Mode of delivery and childhood fractional exhaled nitric oxide, interrupter resistance and asthma: the Generation R study. Pediatr Allergy Immunol 2015; 26 (4): 330-6.
49. Heinrich J, Fuertes E, Flexeder C, et al. Cesarean delivery and risk of childhood obesity. J Pediatr 2014; 164 (5): 1068-73e2.
50. Zhang T, Sidorchuk A, Sevilla-Cermeno L, et al. AssociationofCesareanDeliverywithRiskofNeurodevelopmental and Psychiatric Disorders in the Offspring: Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2 (8): e1910236.

Прикрепленный файлРазмер
2020_01_009-017.pdf634.44 кб

Голосов пока нет