Characterizing the need for re-laparotomy during puerperium after cesarean section.

Abstract

OBJECTIVE:

As inconsistency exists concerning the rate and risk factors for re-laparotomy after cesarean section (CS), we aimed to determine the incidence, risk factors and indications for re-laparotomy after CS.

METHODS:

This is a retrospective study. Women underwent re-laparotomy following CS were compared to a control group in a 1:3 ratio. Demographic, obstetrical and surgical data were analyzed. CS complications were defined as intra-operative abnormal hemorrhage, summoning surgical personnel, inverted T incision, uterine and/or hypogastric arteries ligation or cesarean hysterectomy.

RESULTS:

Overall, 35,779 women delivered during the study, of them 7,926 by CS (22.1 %) and 62 patients (0.7 %) underwent re-laparotomy. Re-laparotomies occur during the first 24 h, first week and beyond it, following CS in 64.5, 22.6 and 12.9 %, respectively. Previous abdominal/pelvic surgery (14.5 vs. 8.1 %, p < 0.01), emergent surgery (24.2 vs. 13.4 %, p = 0.04), intra-operative complications (26.8 vs. 0.5 %, p < 0.001), post-operative complication (40.7 vs. 0.5 %, p < 0.001) and adhesions (65.5 vs. 33.3 %, p < 0.001) were significantly increased in the study group. Indications for re-laparotomy varied according to the interval elapsed to the re-laparotomy with post-partum hemorrhage (27.4 %) being the leading indication in the early period.

CONCLUSION:

Risk factors for re-laparotomy following CS can be recognized and are mainly associated with previous abdominal and/or pelvic surgeries and intra-operative adhesions.

• Authors: Eran Ashwal, Yariv Yogev, Nir Melamed, Rian Khadega, Avi Ben-Haroush, Arnon Wiznitzer, Yoav Peled
• Journal: Archives of gynecology and obstetrics (Arch Gynecol Obstet) Vol. 290 Issue 1 Pg. 35-9 (Jul 2014) ISSN: 1432-0711 [Electronic] Germany
• PMID: 24488580 (Publication Type: Journal Article)

Topics

• Adult
• Blood Loss, Surgical
• Case-Control Studies
• Cesarean Section (adverse effects)
• Female
• Humans
• Hysterectomy (adverse effects)
• Incidence
• Israel (epidemiology)
• Laparotomy
• Logistic Models
• Multivariate Analysis
• Postoperative Complications (epidemiology, etiology)
• Postpartum Hemorrhage (epidemiology, etiology, surgery)
• Postpartum Period
• Pregnancy
• Reoperation (adverse effects)
• Retrospective Studies
• Risk Factors
• Time Factors
• Tissue Adhesions (epidemiology, etiology)
• Treatment Outcome