Perioperative Management and Outcomes After Cesarean Section-A Cross-Sectional Study From Rural Rwanda.

剖宫产围手术期管理及术后结局——来自卢旺达农村地区的横断面研究。

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ID: 12070
2019
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Abstract
Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda.This retrospective cohort study included all women aged ≥ 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported.Of the 621 women included in the study, 45.7% (n = 284) were aged 25-34 y; 42.2% (n = 262) were married; 67.5% (n = 419) had primary education; and 75.7% (n = 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n = 85) of the study population. The most common indication for c-section was having undergone a c-section previously (31.9%, n = 198), followed by acute fetal distress (30.8%, n = 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7% spent less than 4 d at the hospital and 96.1% had no postoperative complications before discharge. Approximately 10% (59/572) of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n = 31).Our study found that previous delivery via c-section was the primary indication for c-section and that most of these cases were emergent or urgent on presentation. This study highlights the need for further research to explore the feasibility, safety, and appropriateness of vaginal birth after cesarean in rural district hospitals in sub-Saharan Africa.
剖宫产术是全球开展最普遍的外科手术，对降低孕产妇和新生儿死亡率至关重要。目前关于非洲农村地区剖宫产医疗照护及结局的研究仍较为匮乏。本研究旨在描述在卢旺达农村基雷赫地区医院（Kirehe District Hospital, KDH）接受剖宫产术的女性的人口学特征、临床处置以及母婴结局。 这项回顾性队列研究纳入了2017年4月1日至9月30日期间，居住在KDH服务辖区内且在该院行剖宫产分娩的所有年龄≥18岁的女性。通过患者访谈和病历调取收集了产妇及其新生儿的人口学与临床特征。进行了描述性分析，并报告频数和百分比。 在纳入研究的621名女性中，45.7%（n = 284）年龄在25至34岁之间；42.2%（n = 262）已婚；67.5%（n = 419）受过小学教育；75.7%（n = 470）职业为农民。居住在邻近马哈马难民营（Mahama Refugee Camp）的布隆迪难民占研究人群的13.7%（n = 85）。最常见的剖宫产指征为既往剖宫产史（31.9%，n = 198），其次为急性胎儿窘迫（30.8%，n = 191）。在以既往剖宫产史为唯一手术指征的病例中，85.4%就诊时属于紧急或急症病例。术后，67.7%的产妇住院时间少于4天，96.1%在出院前未发生术后并发症。约10%（59/572）的新生儿入住新生儿病房，最常见的原因是新生儿感染（59.6%，n = 31）。 本研究发现，既往剖宫产分娩史是实施剖宫产的首要指征，且其中大多数病例在就诊时属于紧急或急症情况。本研究强调，有必要开展进一步研究，以探索在撒哈拉以南非洲农村地区医院开展剖宫产后阴道分娩（VBAC）的可行性、安全性和适宜性。
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mazimpaka2019perioperativethe Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Mazimpaka, Christian;Uwitonze, Eline;Cherian, Teena;Hedt-Gauthier, Bethany;Kateera, Fredrick;Riviello, Robert;El-Khatib, Ziad;Sonderman, Kristin;Gruendl, Magdalena;Habiyakare, Caste;Hakizimana, Sadoscar;Kayitesi, Daniella;Nkurunziza, Theoneste;
Journal The Journal of surgical research
Year 2019
DOI
S0022-4804(19)30564-5
URL
Keywords Keywords not found

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