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 signi cantly 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.

Risk factors for relaparotomy after a cesarean delivery: a case-control study

“…Data regarding relaparotomy after a CD is conflicting. In previous studies, the incidence of this complication ranges widely, with up to a more than ten-fold difference among various reports (0.07-0.9%) [ 5 , 7 , 12 – 18 ]. Moreover, data demonstrates conflicting results regarding risk factors for the need for repeat surgery.…”

“…Although CD is considered a safe procedure, it confers a two-fold higher risk for severe maternal morbidity compared to vaginal delivery [ 4 ]. Amongst the maternal short-term complications after CD is hemorrhage, need for blood products transfusion, intra-abdominal infection, and injury to adjacent organs [ 5 – 7 ], which may warrant a repeat laparotomy (relaparotomy). Relaparotomy is defined as an abdominal operation performed after an initial surgery including skin opening [ 8 , 9 ] and entrance into the abdominal cavity [ 10 ].…”

“…Moreover, data demonstrates conflicting results regarding risk factors for the need for repeat surgery. For example, while some described multiple pregnancies as a risk factor [ 7 , 16 ], others did not find such an association [ 5 , 14 ]. Furthermore, some studies were limited only to re-surgeries due to excessive bleeding [ 9 , 19 ].…”

“…Furthermore, some studies were limited only to re-surgeries due to excessive bleeding [ 9 , 19 ]. In addition, previous studies defined the time from the initial CD to the relaparotomy differently, with some limited to the same hospitalization as the original CD [ 13 , 20 ], whilst others included cases occurring up to one week [ 7 , 9 ], and even six weeks [ 5 ], after the CD. Additionally, there is a paucity of data regarding the indications for relaparotomy following CD stratified by the time interval from the CD to the repeated surgery, with only a few studies [ 5 , 15 ] elaborating on it.…”

“…Additionally, there is a paucity of data regarding the indications for relaparotomy following CD stratified by the time interval from the CD to the repeated surgery, with only a few studies [ 5 , 15 ] elaborating on it. Lastly, most of the previous studies comprised a relatively small number of cases ranging between 18 and 64 [ 5 , 7 , 12 – 14 , 16 – 18 ], with only one comprising 80 patients [ 15 ].…”