Re-laparotomy after cesarean section: operative complications in surgical delivery.
OBJECTIVE
To determine the risk factors causing re-laparotomy and the indications, management and outcomes of re-laparotomy after a cesarean section.


METHODS
We had, during the study period of January 2002 to January 2007, 28,799 cesarean sections and 35 cases with re-laparotomy. We studied the patients' age, parity, indications for cesarean section and indications for re-laparotomy, time interval after cesarean section to reopening of the abdomen, type of surgery, need for blood transfusion and span of hospital stay.


RESULTS
The incidence of re-laparotomy was 0.12%. Cases with placental abruption and previous cesarean > or =3 had a higher risk for re-laparotomy. Procedures that were performed at re-laparotomy were drainage and resuturing of hematomas (n = 8), resuturing of uterus and securing hemostasis with stitches (n = 10), bladder repair (n = 1), herniation repair (n = 1), total abdominal hysterectomy (n = 2), subtotal abdominal hysterectomy (n = 5), and draining and resuturing of broad ligament, parametrium, abdominal wound, and cutaneous and subcutaneous tissue due to infection and abscess formation (n = 8). Two cases required admission into the intensive care unit. We had one case with maternal mortality. Majority of the complications were revealed at an early period and these were hemorrhagic cases mostly.


CONCLUSIONS
Although the rate of re-laparotomy after cesarean section is low, several actions must be undertaken to decrease the need for re-laparotomy. In particular, cases with placental abruption and previous cesarean > or =3 are with higher risk for re-laparotomy and have a 15-fold risk for re-laparotomy after cesarean section.
Gedikbasi
Ali
A
Department of Obstetrics and Gynecology, Istanbul Bakirkoy Maternity and Children Diseases Hospital, Istanbul, Turkey. alged_1971@yahoo.com
Akyol
Alpaslan
A
Asar
Emel
E
Bingol
Banu
B
Uncu
Remzi
R
Sargin
Akif
A
Ceylan
Yavuz
Y
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects*; D018579:Patient Selection; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult