Relaparotomy Post Cesarean Delivery: Characteristics and Risk Factors.

Abstract

Purpose: Relaparotomy following cesarean delivery (CD) is performed at a rate of 0.2-1% of CD. The objective of the present study was to identify risk factors for relaparotomy following CD, and to examine whether there is a difference in the risk of relaparotomy between CD performed during different daytimes. Methods: A retrospective study including all CD over ten years. Cases that underwent laparotomy within one week following CD were compared to those that did not. CDs for placenta accreta were excluded.Results: Sixty-four patients underwent relaparotomy following CD. In univariate analysis relaparotomy was significantly higher pregnancies following assisted-reproductive technologies (39.1%vs. 16.9%), hypertensive disorders of pregnancy (18.8%vs. 7%), twin pregnancies (29.7%vs. 10%), preterm deliveries (34.4%vs. 17.6%), low birthweight (2815gr vs. 3047gr), placenta previa (7.8% vs. 1.3%) low body mass index (22.4 vs. 24.5) and urgent CD (54.7% vs. 40.8%), especially during the second stage of labor. In a multivariate regression analysis, the adjusted odds ratio for relaparotomy was 10.24 in CD due to placenta previa, and 5.28 in CD performed at the second stage of delivery.At relaparotomy, active bleeding was found in 50 patients (78.1%), nearly half received packed cells, 12.5% developed consumptive coagulopathy, and 17.2% needed hospitalization in the intensive care unit. 6.3% underwent a second relaparotomy, mainly due to bleeding.Conclusion: Hypertensive disease, placenta previa, and urgent CDs mainly those performed at the second stage of labor are risk factors for relaparotomy after CD.