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


CONCLUSIONS
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.
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petah Tiqwa, Israel.
Eran
E
Ashwal
Yariv
Y
Yogev
Nir
N
Melamed
Rian
R
Khadega
Avi
A
Ben-Haroush
Arnon
A
Wiznitzer
Yoav
Y
Peled
D000328:Adult; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007813:Laparotomy; D016015:Logistic Models; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome