Subfascial hematomas and hemoperitoneum after cesarean section: prevalence according to closure and non-closure of the parietal peritoneum.
OBJECTIVE
To compare early hemorrhagic complications and the surgical and clinical outcome in the closure and non-closure of the parietal peritoneum in cesarean section (CS) patients.


METHODS
We retrospectively evaluated 2,576 post-CS women subdivided and compared in two groups by open and closed parietal peritoneum (group I, n = 1,580, group II, n = 996).


RESULTS
The ultrasonographical detection of 23 blood collections (0.89%) was 14 in group I and 9 in group II, and of these we surgically treated 11 patients in group I and 8 patients in group II, with no statistical difference (p > 0.05); all group I patients showed hemoglobin point decreases and needed blood transfusions, with statistical significance (p < 0.05) linked to more severe early complications that make the post-CS outcome worse; no difference was confirmed in terms of antibiotic administration (p > 0.05).


CONCLUSIONS
There was a significant increase of blood loss and transfusions in the first group. As the posterior surface of the Retzius space is open and if post-CS pathological bleeding occurs, blood can invade the peritoneal cavity causing a hemoperitoneum, with the possibility of hemorrhagic shock and a worse clinical outcome.
Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy. ant.malvasi@tiscali.it
Antonio
A
Malvasi
Andrea
A
Tinelli
Raffaele
R
Tinelli
Gabriella
G
Serio
Marcello
M
Pellegrino
Liselotte
L
Mettler
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography