OBJECTIVE: 

To compare maternal outcomes in subsequent pregnancies of patients who had a prior classical cesarean delivery with those with a prior low transverse cesarean delivery.

METHODS: 

We conducted a cross-sectional analysis of patients with live singleton births at or after 24 weeks of gestation who had a prior classical cesarean delivery or a low transverse cesarean delivery in the 2016–2019 National Inpatient Sample database. Outcome measures included mode of delivery, uterine rupture, and severe maternal morbidity (SMM), as defined by the Centers for Disease Control and Prevention. Maternal outcomes were compared using the χ² test and the propensity score method, accounting for differences in patients' clinical risk factors. Multivariable regressions further assessed how patients' sociodemographic and hospital characteristics might influence the differences in maternal outcomes between the two groups.

RESULTS: 

The sample included 1,671,249 patients: 25,540 with prior classical cesarean delivery and 1,645,709 with prior low transverse cesarean delivery. Cesarean delivery occurred in 95.5% of patients with prior classical cesarean compared with 91.3% of those with prior low transverse delivery (P<.001; propensity score method: odds ratio [OR] 0.99, 95% CI 0.85–1.16) and uterine rupture occurred in 1.1% and 0.3%, respectively (P<.001; propensity score method: OR 2.17, 95% CI 1.40–3.36). Among patients with prior classical cesarean delivery, uterine rupture occurred in 10.6% of those who underwent labor compared with 0.3% of those who did not (P<.001). Rates of SMM were 5.9% and 2.0% in the two groups, respectively (P<.001; propensity score method: OR 1.87, 95% CI 1.53–2.29). After adjustment of maternal sociodemographic and hospital characteristics, differences in the risk of uterine rupture and SMM between the two groups were attenuated but remained significant.

CONCLUSION: 

Prior classical cesarean delivery was associated with a higher risk of uterine rupture and SMM in subsequent pregnancies, compared with prior low transverse cesarean delivery, even after accounting for patients' clinical, sociodemographic, and hospital characteristics.

中文翻译：

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经典剖宫产后后续妊娠的产妇结局

客观的： 

比较既往接受过经典剖宫产术和接受过低位横剖宫产术的患者在后续妊娠中的母体结局。

方法： 

我们对 2016-2019 年全国住院患者样本数据库中曾接受过经典剖宫产或低位横向剖宫产的妊娠 24 周或之后的单胎活产患者进行了横断面分析。结果测量包括疾病控制和预防中心定义的分娩方式、子宫破裂和严重孕产妇发病率 (SMM)。^使用χ2检验和倾向评分法比较母体结果，说明患者临床危险因素的差异。多变量回归进一步评估了患者的社会人口学和医院特征如何影响两组之间孕产妇结局的差异。

结果： 

样本包括 1,671,249 名患者：25,540 名既往接受过经典剖宫产术，1,645,709 名患者接受过低位横剖宫产术。剖宫产发生在 95.5% 的既往经典剖宫产患者中，而在既往低位横向分娩（P <.001；倾向评分法：比值比 [OR] 0.99，95% CI 0.85–1.16）和子宫破裂的患者中，这一比例为 91.3%发生率分别为 1.1% 和 0.3%（P <.001；倾向评分法：OR 2.17，95% CI 1.40–3.36）。在既往进行过经典剖宫产的患者中，有 10.6% 的分娩患者发生子宫破裂，而没有分娩的患者为 0.3%（P <.001）。两组 SMM 发生率分别为 5.9% 和 2.0%（P<.001; 倾向评分法：OR 1.87，95% CI 1.53–2.29）。在调整产妇社会人口学和医院特征后，两组之间子宫破裂和 SMM 风险的差异有所减弱，但仍然显着。

结论： 

即使在考虑了患者的临床、社会人口学和医院特征后，与之前的低横向剖宫产相比，既往经典剖宫产与后续妊娠中子宫破裂和 SMM 的风险较高有关。