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首页> 外文期刊>International Journal of Reproduction, Contraception, Obstetrics and Gynecology >Is scar tenderness a reliable sign of scar complications in labor?
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Is scar tenderness a reliable sign of scar complications in labor?

机译：疤痕压痛是分娩时疤痕并发症的可靠标志吗？

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Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG), severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor. Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor of scar complications in labour (p value=0.2). Past history of D&E has relative risk of 2.85 for scar complications. Conclusions: Scar tenderness is a sensitive sign of scar complications and should continue to be elicited for all women undergoing trial of labor after previous caesarean.
机译：背景：剖宫产术从一种危险且限制性的手术到安全，快速的手术已经走了很长一段路。由于全球主要剖腹产的比率上升，重复剖宫产也变得非常普遍。子宫有疤痕的分娩过程中最主要的担心是疤痕破裂，这会破坏胎儿和产妇，包括死亡率。多项研究监测疤痕破裂的特征，如心电图异常（CTG），紧缩之间持续存在严重腹痛，急性发作性疤痕压痛，血尿或阴道异常出血，产妇心动过速或休克，子宫活动停止和丧失就诊位除疤痕压痛外，其余部分均存在，该痕迹尚未在任何研究中进行单独评估。本前瞻性观察性研究是在三级医院进行的，旨在评估疤痕压痛作为分娩中疤痕并发症的征兆的敏感性和特异性。方法：对78名在足月进行瘢痕试验的自发分娩前剖宫产的妇女进行分娩监测，每隔30分钟观察一次阴道出血，疤痕压痛，产妇脉搏和血压。压迫子宫收缩之间的耻骨联合下方和后面引起疤痕压痛，同时让该妇女参与交谈并注意可见的畏缩。按照方案进行胎儿心率听诊。由于疤痕压痛，无法解释的产妇心动过速，新鲜的阴道出血，胎儿心率异常和分娩进展，终止了疤痕试验。结果：作为疤痕并发症预测指标的疤痕压痛敏感性和特异性分别为92.3％和3.8％，而准确性为33.3％。疤痕压痛阳性迹象与分娩中的疤痕并发症相关的可能性比为1.48。产妇心动过速不是疤痕并发症的重要预测指标（p值= 0.2）。 D＆E的既往史相对而言，疤痕并发症的相对风险为2.85。结论：疤痕压痛是疤痕并发症的敏感标志，应该对所有经过剖腹产后进行分娩试验的妇女继续引起。

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