title: Risk factors for relaparotomy after cesarean delivery.
abstract: OBJECTIVE
  To identify risk factors for relaparotomy after cesarean delivery.
  
  
  METHODS
  Cases of exploratory laparotomy at Lis Maternity Hospital, Tel Aviv, Israel, following cesarean delivery between 2000 and 2010 were reviewed retrospectively. Each case in the study group was matched randomly with 5 control cases in which the patient underwent cesarean delivery only. Demographic and clinical data before and during the primary procedure were compared.
  
  
  RESULTS
  Twenty-eight (0.2%) of 17482 cesarean deliveries were followed by exploratory relaparotomy. Significant differences between the study and the control (n=140) groups were found in: placental abruption as an indication for cesarean (17.8% vs 0.6%; P=0.004); duration of primary operation (45.3 ± 21.1 vs 29.9 ± 11.8 minutes; P=0.007; 95% CI, 5.1-19.2); and experience of chief surgeon (10.1 ± 1.6 vs 5.8 ± 0.4 years; P=0.02; 95% CI, 0.0-5.0). Findings during relaparotomy were: abdominal wall bleeding/hematoma (n=4 [14.2%]); uterine scar bleeding (n=4 [14.2%]); retroperitoneal bleeding (n=1 [3.5%]); adhesions causing bowel obstruction (n=1 [3.5%]); and uterine scar gangrene (n=1 [3.5%]). There were no findings for 17 (60.7%) patients.
  
  
  CONCLUSIONS
  The incidence of relaparotomy following cesarean was 0.2% (1 per 624 cesarean deliveries). Significant risk factors were placental abruption and longer operative time.
authors.affiliation: Department of Gynecology, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. ilevin@post.tau.ac.il
authors.forename: Ishai
authors.initials: I
authors.lastname: Levin
authors.forename: Avital S
authors.initials: AS
authors.lastname: Rapaport
authors.forename: Liat
authors.initials: L
authors.lastname: Salzer
authors.forename: Liat
authors.initials: L
authors.lastname: Satzer
authors.forename: Sharon
authors.initials: S
authors.lastname: Maslovitz
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: Benny
authors.initials: B
authors.lastname: Almog
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology*; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007557:Israel; D007813:Laparotomy / Q000379:methods*; D006473:Postpartum Hemorrhage / Q000601:surgery; D011247:Pregnancy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors