Tiết lộ các chỉ định không tối ưu cho các ca phẫu thuật mổ lấy thai khẩn cấp do tình trạng thai nhi bất thường và chuyển dạ kéo dài: một nghiên cứu cắt ngang đa trung tâm tại 12 bệnh viện công ở Nepal
Tóm tắt
Tỷ lệ phẫu thuật mổ lấy thai (CS) toàn cầu đã gây lo ngại về việc lạm dụng tiềm tàng phương pháp này ở cả những khu vực có nguồn lực cao và thấp. Chúng tôi đã tiến hành đánh giá quản lý và kết quả của các ca sinh có mổ lấy thai khẩn cấp do tình trạng thai nhi nguy kịch và chuyển dạ kéo dài tại 12 bệnh viện công ở Nepal và xác định các yếu tố liên quan đến các chỉ định CS không tối ưu.
Chúng tôi đã thực hiện một nghiên cứu cắt ngang trên tất cả các ca sinh từ ngày 14 tháng 4 năm 2017 đến ngày 17 tháng 10 năm 2018 tại 12 bệnh viện công ở Nepal và bao gồm tất cả các ca mổ lấy thai khẩn cấp do tình trạng thai nhi nguy kịch và chuyển dạ kéo dài. Phân tích được thực hiện sử dụng kiểm định chi bình phương Pearson và hồi quy logistic đơn biến và đa biến.
Tổng số khám phá bao gồm 104,322 ca sinh trong đó có 18,964 ca (18%) là mổ lấy thai (13,095 [13%] là mổ lấy thai khẩn cấp và 5,230 [5.0%] là mổ lấy thai theo yêu cầu). Chúng tôi đã xác định được 1,806 ca mổ lấy thai khẩn cấp do tình trạng thai nhi nguy kịch và 1,322 ca mổ lấy thai khẩn cấp do chuyển dạ kéo dài. Trong số các ca mổ lấy thai do tình trạng thai nhi nguy kịch, chỉ có 36% được theo dõi nhịp tim thai nhi theo quy trình, và trong số các ca mổ lấy thai do chuyển dạ kéo dài, biểu đồ thai chỉ được điền đầy đủ trong 8.6%. Độ tuổi thai < 37 tuần và cân nặng lúc sinh < 2500 g có liên quan đến nhiều chỉ định CS không tối ưu hơn (tỷ lệ odds đã điều chỉnh [aOR] 1.4, khoảng tin cậy [CI] 95% 1.1–1.8 và aOR 1.7, CI 95% 1.3–2.2 tương ứng) so với những ca có độ tuổi thai > 37 tuần và cân nặng lúc sinh > 2500 g. Chúng tôi không tìm thấy mối liên hệ nào giữa các chỉ định CS không tối ưu với dân tộc mẹ hoặc trình độ học vấn.
Từ khóa
#phẫu thuật mổ lấy thai #chỉ định không tối ưu #tình trạng thai nhi #chuyển dạ kéo dài #nghiên cứu cắt ngangTài liệu tham khảo
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