Risk factors for relaparotomy after caesarian section: a study in a tertiary care hospital

Abstract

INTRODUCTIONCaesarian section or C-section or CS, is one of the most common operations carried out in daily obstetric practice. Especially, with the improvement in the techniques, safe anaesthesia, safe transfusions and other techniques, the rate of the C-sections over the years have increased considerable, with many women electing to have a CS rather than normal vaginal delivery. With more and more women becoming career minded and increase the age of first pregnancy, CS has become the most preferred mode of delivery.1 Moreover, caesarian section is an effective way to circumvent maternal and foetal compliations. There has been a dramatic rise of caesarian section over the years in many countries in some cases upto 25%.3 In Europe, the operations have risen seven and a half fold from 3.3% in 1967 to 25% in 1995. 4 In some places in Asia, cesarean section rate is 8%. 5This rise of CS has been attributed to many causes such as pregnancy after 35 years and maternal requests. Also changes in maternal characteristics such as increase in obesity and diabetes are also a few other reasons. The obstetric practices such as labor induction and epidural anesthesia all have contributed to the rise in the rate of CS rate. 6 ABSTRACT Background: Caesarian section (CS) is one of the most common reasons for the development of puerperal complications. Most of the women are treated conservatively, but sometimes there is a need for relaparotomy. Usually it is performed when the condition of the patient is too critical to withstand the risk of anaesthesia and repeat operation. Methods: Detailed demographic data was collected from the patients such as age, parity, indication for primary caesarian section, indications for relaparotomy and the interval between the two surgeries. Results: Most of the women were in the age group of 20-35 years with 1 case being 38 and most of them were multiparous except 3 for whom this was the first parity. Atonic post-partum haemorrhage was the most common indication for relaparotomy followed by traumatic postpartum haemorrhage and rectus sheath hematoma. Most of the surgeries took place within the first 24 hours of the primary surgery. Conclusions: Since there is a high rate of indications for relaparotomy, immediate action and careful monitoring of the patient is required post caesarian section.