Closure versus non-closure of the visceral peritoneum (VP) in patients with gestational hypertension--an observational analysis.
BACKGROUND
Caesarean section (CS) is one of the most frequently performed surgical procedures worldwide. Surgical variants include closure and non-closure of the peritoneum: in case of non-suturing the visceral peritoneum (VP), abnormal fluid collections such as blood clots may lead to formation of a hematoperitoneum.


METHODS
In this retrospective, observational study we reviewed 1848 patients with gestational hypertension (GH) undergoing repeat and primary CS performed by non-closure of the visceral peritoneum (VP).


RESULTS
Six of these patients had major early post-CS complications: 5 patients experienced hypovolaemic shock that required urgent operative intervention. Four patients underwent repeat laparotomy and one patient was treated by laparoscopy.


CONCLUSIONS
As an early major post-CS complication, hematoperitoneum occurs in cases with poor haemostasis and/or with haemodynamic disorders such as GH. A decrease in blood pressure (BP) during CS caused by spinal/epidural anaesthesia and the following BP increase in GH patients may favour bleeding complications. Closure of the VP may facilitate early detection of a subperitoneal hematoma. In contrast, hematoperitoneum may develop in cases of non-closure of the VP followed by hypovolemic shock. Early and aggressive intervention results in excellent prognosis of this complication.
Santa Maria Hospital, Obstetric & Gynaecology, Bari, Italy.
Antonio
A
Malvasi
Andrea
A
Tinelli
Gernot
G
Hudelist
Daniele
D
Vergara
Roberta
R
Martignago
Raffaele
R
Tinelli
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000601:surgery*; D008499:Medical Records; D010537:Peritoneum / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012773:Shock, Surgical; D013536:Suture Techniques / Q000009:adverse effects*; D016896:Treatment Outcome