Volume 7, Issue 2, March 2019, Page: 56-59
Caesarean in Case of Scar Uterus: Indications and Maternal and Neonatal Prognosis at the University Hospital of Brazzaville (Republic of Congo)
Itoua Clautaire, Gynecology Obstetrics Department, University Hospital of Brazzaville, Brazzaville, Congo
Iloki Itoba Imongui Sandra, Gynecology Obstetrics Department, University Hospital of Brazzaville, Brazzaville, Congo
Buambo Gauthier Régis Jostin, Gynecology Obstetrics Department, University Hospital of Brazzaville, Brazzaville, Congo
Potokoue Mpia Samantha Nuelly, Gynecology Obstetrics Department, University Hospital of Brazzaville, Brazzaville, Congo
Mokoko Jules César, Gynecology Obstetrics Department, University Hospital of Brazzaville, Brazzaville, Congo
Ngakengni Nelie Yvette, Neonatology Department, University Hospital of Brazzaville, Brazzaville, Congo
Eouani Max Levy Eméry, Gynecology Obstetrics Department, General Hospital of Loandjili, Pointe Noire, Congo
Iloki Léon Hervé, Gynecology Obstetrics Department, University Hospital of Brazzaville, Brazzaville, Congo
Received: Mar. 21, 2019;       Accepted: Apr. 25, 2019;       Published: May 20, 2019
DOI: 10.11648/j.jgo.20190702.16      View  35      Downloads  11
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.
Keywords
Scarred Uterus, Caesarean, Prognosis, Brazzaville
To cite this article
Itoua Clautaire, Iloki Itoba Imongui Sandra, Buambo Gauthier Régis Jostin, Potokoue Mpia Samantha Nuelly, Mokoko Jules César, Ngakengni Nelie Yvette, Eouani Max Levy Eméry, Iloki Léon Hervé, Caesarean in Case of Scar Uterus: Indications and Maternal and Neonatal Prognosis at the University Hospital of Brazzaville (Republic of Congo), Journal of Gynecology and Obstetrics. Vol. 7, No. 2, 2019, pp. 56-59. doi: 10.11648/j.jgo.20190702.16
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Cassignol C, Rudigoz RC. Pregnancy and uterus scar. Encycl Méd Chir. Gynécologie/Obstétrique, 5-016-D-20, 2003, 15 p.
[2]
Deneux-Tharaux C. Scar uterus: epidemiological aspects. J Gynecol Obstet Biol Reprod 2012; 41: 697-707.
[3]
CNGOF (Collège National des Gynécologues et Obstétriciens Français). Recommendations for clinical practice: delivery in the case of scar uteri. 2012; 91: 607-619.
[4]
Lucas DN, Yentis SM, Kinsella SM et al. Urgency of caesarean section: a new classification. J R Soc Med 2000; 93: 346-50.
[5]
Koulimaya-Gombet CE, Diouf AA, Diallo M, Dia A, Sène C, Moreau JC, et al. Pregnancy and delivery of patients with a history of caesarean of Dakar: therapeutic and prognostic, epidemiological-clinical aspects. Pan Afr Med J 2017; 27: 135.
[6]
Kitenge FM, Chenge FM, Kinenkinda XK, Luboya ON, Tshibangu CK, Mashinda DK, et al. Vital issue, maternal and perinatal morbidity and mortality on delivery with scar uterus in some hospitals in the Democratic Republic of Congo. Ann Afr Med 2017; 10: 2526-34.
[7]
Traoré Y, Tegueté I, Dicko FT, Diallo A, Djiré MY, Sissoko A et al. Delivery in a cicatricial uterus context at Gabriel Touré University Hospital from January 2007 to December 2008: modalities and complications. Med Afr Noire 2012; 45: 512-6.
[8]
Koh MV, Essome H, Sama DJ, Foumane P, Ebah BM. Delivery of scar uteri in low-ressource countries: management and maternal-fetal care circuit. Pan Afr Med J 2018; 30: 255.
[9]
Kintege FM, Akilimali PZ, Chenge FM, Numbi OL, Tshibangu CK, Mashinda D, et al. Scarred uterine delivery in the Democratic Republic of Congo: uterine trial and determinants of outcome. Pan Afr Med J 2017; 27:71.
[10]
Baldé IS, Sy T, Diallo A, Baldé O, Diallo MH, Diallo MC, et al. Childbirth in a context of scar uterus at the maternity ward of the Ignace-Deen National Hospital (Guinea). Rev Méd Périnat 2017; 9: 32-6.
[11]
Boisselier P, Monghioras P, Marpeaux L. Evolution in Caesarean section indicationsfrom 1977 to 1983. About 18605 deliveries. J Gynecol Obstet Biol Reprod 1987; 16: 151-60.
[12]
Arzel A, Boulot P, Mercier G, Letois F. National survey on the management of the delivery of uteri in France in 2009. J Gynecol Obstet Biol Reprod 2012; 41: 445-53.
[13]
Sans-Mischel AC, Trastour C, Sakarovitch C, Delotte J, Fontas E, Bongain A. State of play in France of the management of cicatricial uteri. J Gynecol Obstet Biol Reprod 2012 40: 639-50.
[14]
Martel MJ, Mackinnon CJ. Guidelines for vaginal birth after previous caesarean birth. J Obstet Gynaecol Can 2005; 27: 164-88.
[15]
Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBA-2): a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG 2010; 117: 5-19.
[16]
Kayem G, Raiffort C, Legardeur H, Gavard L, Mandelbrot L, Girard G. Criteria for acceptance of the vaginal route according to the characteristics of the uterine scar. J Gynecol Obstet Biol Reprod 2012; 41: 753-71.
[17]
Beucher G, Dolley P, Lévy-Thissier S, Florian A, Dreyfus M. Maternal benefits and risks of the vaginal approach compared to the planned cesarean section in case of a previous caesarean section. J Gynécol Obstet Biol Reprod 2012; 41: 708-26.
[18]
Dieme FME, Moriera P, Tamofo E, Diouf AA, Diouf A, Moreau J-C. Followed pregnancies on uterus scar: qualitative aspect and clinical implication. Méd S Trop 2014; 24: 409-15.
Browse journals by subject