Nhận xét kết quả mổ lấy thai vì đầu không lọt tại Bệnh viện Phụ sản Trung ương

Cesarean section (CS) due to failure of head descent represents a notable proportion of obstetric interventions, posing significant challenges for both mother and fetus. Studies indicate varying but substantial incidences of this condition, with reported rates in Vietnam ranging from 17% to 26.8%. Such cases are often complicated by a prolonged low fetal head, extensive caput succedaneum, and increased risks of uterine tears, lower segment injury, major vessel damage, and potential trauma to the bladder or fetus. Understanding the specific outcomes and management strategies for this indication is crucial for improving patient safety and minimizing complications. This study aims to evaluate the outcomes of cesarean sections performed for failure of head descent at the National Hospital of Obstetrics and Gynecology, providing valuable insights for clinical practice.

Các bác sĩ sản phụ khoa, bác sĩ nội trú, sinh viên y khoa và các nhà nghiên cứu trong lĩnh vực sản khoa quan tâm đến quản lý và kết cục của mổ lấy thai vì đầu không lọt.

This descriptive cross-sectional study aimed to evaluate the outcomes of cesarean sections (CS) performed for failure of head descent at the National Hospital of Obstetrics and Gynecology, analyzing 218 cases from the first six months of 2024. The findings revealed that the majority of cases involved gestational ages between 37 and 40 weeks (64.2%), predominantly in primiparous women (59.6%). Neonates generally had birth weights between 3000-3500 grams (59.6%), and all exhibited good Apgar scores (>7) at both 1 and 5 minutes, indicating favorable immediate neonatal outcomes despite the challenging indication. Regarding surgical timing, a significant proportion (93.1%) of operations were performed within 60-90 minutes following full cervical dilation. Furthermore, most cases (64.2%) proceeded to surgery within 6 hours of membrane rupture, with 14.7% occurring after 12 hours, which is noted as a risk factor for infection. Complications were observed in 7.3% of cases (16 out of 218), primarily involving extension of the uterine incision (5.5%), followed by placental site hemorrhage, accidental ureteral suture, and surgical site infection (all at lower rates). The study concludes that timely and appropriate surgical intervention for failure of head descent cases is crucial for maximizing patient safety and effectively minimizing the risk of adverse events and postoperative complications. This underscores the importance of experienced surgical teams and meticulous timing in managing these high-risk deliveries, particularly in primiparous women where the condition is more prevalent, to achieve optimal maternal and neonatal outcomes.