title: Re-laparotomy following cesarean delivery - risk factors and outcomes.
abstract: BACKGROUND
  Re-laparotomy following caesarean delivery (CD) is a rare yet serious complication. The aim of this study was to identify risk factors, diagnostic features and outcomes following re-laparotomy.
  
  
  METHODS
  This retrospective cohort study reviewed cases of re-laparotomy following CD performed at Hadassah-Hebrew University Medical Center. Occurrences were identified via the electronic medical record database.
  
  
  RESULTS
  During the study period, 17,213 women underwent CD, of which 55 (0.3%) underwent re-laparotomy during the same hospitalization. Main indications for re-laparotomy were intra-peritoneal bleeding (62%) and wound infection/dehiscence (22%). During re-laparotomy, the bleeding source was found and ligated in 85% of the cases. Age, parity, previous CD, induction of labor, anesthesia type and operative duration were significant risk factors for re-laparotomy. In a selected group of patients, trial of conservative treatment was made. However, in 76% of these women a re-laparotomy was required.
  
  
  CONCLUSIONS
  Risk factors for re-laparotomy following CD should be identified, thus enabling more intensified monitoring of patients considered at risk for this complication. When intra-peritoneal bleeding following CD is suspected, conservative management has a high failure rate and should be reserved for a selected group of stable patients.
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Lorinne
authors.initials: L
authors.lastname: Levitt
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Hana
authors.initials: H
authors.lastname: Sapir
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Kabiri
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Eliana
authors.initials: E
authors.lastname: Ein-Mor
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Drorith
authors.initials: D
authors.lastname: Hochner-Celnikier
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Hagai
authors.initials: H
authors.lastname: Amsalem
mesh_terms: D000293:Adolescent; D000328:Adult; D016913:Blood Component Transfusion; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006465:Hemoperitoneum / Q000601:surgery; D006801:Humans; D007751:Labor, Induced; D007813:Laparotomy / Q000706:statistics & numerical data*; D008423:Maternal Age; D008875:Middle Aged; D061646:Operative Time; D010298:Parity; D011247:Pregnancy; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery; D055815:Young Adult
keywords: Bleeding; dehiscence; surgery; wound infection