title: Return to the Operation Theatre: An Analysis of Repeat Surgeries in Operative Obstetrics.
abstract: OBJECTIVE
  To determine the risk factors and associated comorbidities with a relaparotomy after primary surgery in pregnant mothers and to identify preventable causes.
  
  
  METHODS
  A retrospective observational study was done at a tertiary care centre from January 2009 till August 2014. All records of exploratory laparotomy following primary surgery in the obstetric population during this period were retrieved from the hospital database and analysed.
  
  
  RESULTS
  The incidence of relaparotomy was 0.22 %. In 94 % cases, the primary surgery was caesarean section. The commonest indication for relaparotomy was due to haemorrhagic complications like bleeding and haematoma (66.8 %). Sepsis was seen in 36.1 % cases with the predominant organism isolated being E coli (54 %). Most common comorbidity was hypertensive disorders (58 %) followed by liver disorders (19 %). 33.3 % needed ventilatory support, 30.5 % needed massive blood transfusion, 16.6 % were on total parenteral nutrition and 2.7 % needed renal replacement therapy. Maternal mortality was 2.8 %.
  
  
  CONCLUSIONS
  Relaparotomy following caesarean section is considered a near-miss mortality. Care must be taken in primary surgery with meticulous attention to haemostasis. Strict postoperative vigilance must be adhered to for timely detection of complications and appropriate intervention.
authors.affiliation: Fernandez Hospital, Hyderabad, India.
authors.forename: Maimoona
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Fernandez Hospital, Hyderabad, India.
authors.forename: Sunil T
authors.initials: ST
authors.lastname: Pandya
authors.affiliation: Fernandez Hospital, Hyderabad, India.
authors.forename: Tarakeswari
authors.initials: T
authors.lastname: Supraneni
keywords: Caesarean section; Hemorrhage; Near-miss mortality; Relaparotomy; Sepsis