Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding

Akkurt, Mehmet Özgür; Çoşkun, Bora; Güçlü, Tuğberk; Çift, Tayfur; Korkmazer, Engin

doi:10.1080/14767058.2018.1527309

Cited by 12 publications

(15 citation statements)

References 13 publications

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“…Similar to previous studies 1,5 , we found that hypertensive diseases of pregnancy were associated with a signi cant risk of relaparotomy. Ahmed et al found that the most common comorbidity in patients with relaparotomy was hypertensive disorders 22 .…”

Section: Resultssupporting

confidence: 90%

“…Relaparotomy following cesarean delivery (CD) is de ned as an additional abdominal surgery for exploration within 60 days of CD including skin opening 1 . It is usually an urgent medical condition, complicating about 0.2-1% of CD, and is performed mainly due to abdominal bleeding, abdominal wall hematoma, uncontrolled bleeding and infections [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

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Relaparotomy Post Cesarean Delivery: Characteristics and Risk Factors.

Weissmann-Brenner

Eran

Meyer

et al. 2021

Preprint

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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.

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Section: Resultssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Relaparotomy Post Cesarean Delivery: Characteristics and Risk Factors.

Weissmann-Brenner

Eran

Meyer

et al. 2021

Preprint

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“…The actual LOS observed for different time periods correspond to the LOS reported by previous studies in Denmark as well as internationally 2,14,28‐30 . A Danish study reported a mean LOS of nearly 5 days after CS in 2001, 14 whereas another Danish study found a median LOS of 2.7 days in 2013‐2014 2 .…”

Section: Discussionsupporting

confidence: 81%

“…When factors related to birth, health and demography were accounted for, we found a reduction of 30 hours from 2004 to 2016 in median LOS after CS in Denmark. A decrease was seen across all five Danish regions but with large variability between the regions.The actual LOS observed for different time periods correspond to the LOS reported by previous studies in Denmark as well as internationally 2,14,[28][29][30]. A Danish study reported a mean LOS of nearly 5 days after CS in 2001,14 whereas another Danish study found a median LOS of 2.7 days in 2013-2014 2.…”

supporting

confidence: 81%

Length of hospital stay after cesarean section in Denmark from 2004 to 2016: A national register‐based study

Kruse

Arendt

Jakobsen

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Length of hospital stay after birth has decreased during the last decades, but nationwide data on length of hospital stay after cesarean section are lacking. Elements of Enhanced Recovery Programs were reported to reduce the length of hospital stay. The aim of this nationwide study was to describe the length of hospital stay after cesarean section in Denmark from 2004 to 2016 taking into account birth‐ and health‐related factors as well as demographic changes and, further, to assess potential differences between the five Danish regions. Material and methods Length of hospital stay was assessed in 164 209 deliveries by cesarean section in Denmark from 2004 to 2016. Data were obtained from the Danish National Patient Register. All deliveries by cesarean section at gestational age <22 weeks were excluded. Median length of hospital stay was reported based on crude and adjusted analyses. Results The median length of hospital stay was significantly reduced by 39 hours (95% confidence interval [CI] 37.9‐40.1), from 97 hours (4.0 days) in 2004 to 58 hours (2.4 days) in 2016. Reductions were observed among both planned and emergency cesarean sections. When birth‐ and health‐related factors as well as demographic changes were accounted for, median length of hospital stay was reduced by 30 hours (95% CI 29.3‐30.8) in the period. The decrease in length of hospital stay from 2004 to 2016 varied between the five Danish regions, with adjusted reductions between 19 and 46 hours. Conclusions A nationwide decrease in length of hospital stay after cesarean section was observed from 2004 to 2016 across all five regions but with significant regional variations. Further studies on the optimal length of hospital stay are needed, especially with regard to implementation of enhanced recovery programs.

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“…As a rule, the rate is lower in tertiary level institutions [5]. Hemodynamic instability as a consequence of suspected intraabdominal and/or vaginal bleeding is reported to be the most common indication for relaparotomy after CS, accounting for approximately 66-68% of the cases [9,10,11]. For these reasons, relaparotomy is most commonly performed within the first five hours of CS, which corresponds to clinical picture of hemodynamic instability [6].…”

Section: Discussionmentioning

confidence: 99%

Surgical complications of cesarean section

et al. 2019

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Introduction/Objective Cesarean section birth rate has been constantly increasing worldwide over the last decades. The complications of cesarean section that require relaparotomy are rather serious and relatively rare. The aim of this paper is to present the incidence of surgical complications after Cesarean section at the Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia, during a three-year period (2013-2015). Methods This is a retrospective study. Data obtained from the medical records/histories were used and processed according to descriptive statistical methods. Results During the observed period, relaparotomy was necessary in 29 (0.44%) women who had a CS. Relaparotomy was performed due to clinically and ultrasonographically evidenced hematoma of the anterior abdominal wall, retroperitoneal hematoma, hemoperitoneum, and development of hemorrhagic shock, complete wound dehiscence or diffuse peritonitis. There were no lethal outcomes after CS followed by these complications at the Clinic of Gynecology and Obstetrics, Clinical Center of Serbia in Belgrade. Conclusion The incidence of relaparotomy in our study is similar to other tertiary institutions, as well as the indications for relaparotomy. While generally observed mortality rate after post-cesarean relaparotomy in developed countries is 2.7%, in our study there were no lethal outcomes.

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Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding

Cited by 12 publications

References 13 publications

Relaparotomy Post Cesarean Delivery: Characteristics and Risk Factors.

Relaparotomy Post Cesarean Delivery: Characteristics and Risk Factors.

Length of hospital stay after cesarean section in Denmark from 2004 to 2016: A national register‐based study

Surgical complications of cesarean section

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