Re-laparotomy After Cesarean Section: Risk, Indications and Management Options

Aim: To identify risks, indications and outcomes for relaparotomy after cesarean delivery. Methods: A prospective case-controlled study conducted at Mansoura University Hospital, Egypt from 2009 to 2012. Each case was matched randomly to 2 cases that had delivered by cesarean section during the same period and did not undergo repeated surgical intervention. Information’s on indications were obtained to gather information’s on risks factors. Results: relaparotomy complicated 1.04 %( n= 26) of the total number of the cesarean section (CS) (n=2500). The principal indications for relaparotomy were internal bleeding (Intra-abdominal bleeding in 41.7% (n=10); rectus sheath hematoma in 29.2% (n=7) and uncontrolled postpartum hemorrhage (PPH) in 29.2 %( n=7) of cases, followed by infections in 7.7% (n=2) of cases. Resulting in 11.5 %( n=3) maternal death. Predictors for relaparotomy after cesarean delivery from univariate logistic model, placenta previa (OR=6.898, 95% CI=1.867- 25.4, P=.004), fetal weight greater than 4 kg (OR=6.409, 95% CI=1.444-28.44, .015). Previous cesarean section and parity were not a risk for re-laparotomy. Conclusion: In this study, the incidence of relaparotomy after cesarean delivery was very high (1.04%). Associated with high maternal mortality (11.5%).The main predictors were placenta previa and fetal macrosomia.