Skip to main content

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

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Greenhill JP (1995) Obstetrics, 11th edn. Saunders, Philadelphia, pp 986–1013

    Google Scholar 

  2. 2.

    Joseph KS, Young DC, Dodds L, O’Connell CM, Allen VM, Chandra S et al (2003) Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol 102(4):791–800

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM (2006) Caesarean section for non-medical reasons at term. Cochrane Database Syst Rev 3:CD004660

    PubMed  Google Scholar 

  4. 4.

    Zelop C, Heffner LJ (2004) The downside of cesarean delivery: short- and long-term complications. Clin Obstet Gynecol 47:386–393

    PubMed  Article  Google Scholar 

  5. 5.

    Bergholt T, Stenderup JK, Vedsted-Jakobsen A, Helm P, Lenstrup C (2003) Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors. Acta Obstet Gynecol Scand 82(3):251–256

    PubMed  Article  Google Scholar 

  6. 6.

    Van Ham M, Van Dongen P, Mulder J (1997) Maternal consequences of caesarean section: a retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 74:1–6

    PubMed  Article  Google Scholar 

  7. 7.

    Mayer HG, Limberger M (1975) Early abdominal second interventions following gynecologic surgery. Zentralbl Gynakol 97:692–695

    CAS  PubMed  Google Scholar 

  8. 8.

    Seffah JD (2005) Re-laparotomy after cesarean section. Int J Gynaecol Obstet 88(3):253–257

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Kessous R, Danor D, Weintraub YA, Wiznitzer A, Sergienko R, Ohel I, Sheiner E (2012) Risk factors for re-laparotomy after cesarean section. J Matern Fetal Neonatal Med 25(11):2167–2170

    PubMed  Article  Google Scholar 

  10. 10.

    Lurie S, Sadan O, Golan A (2007) Re-laparotomy after cesarean section. Eur J Obstet Gynecol Reprod Biol 134(2):184–187

    PubMed  Article  Google Scholar 

  11. 11.

    Levin I, Rapaport AS, Satzer L, Maslovitz S, Lessing JB, Almog B (2012) Risk factors for re-laparotomy after cesàrean delivery. Int J Gynaecol Obstet 119(2):163–165

    PubMed  Article  Google Scholar 

  12. 12.

    Nielsen TF, Hökegård KH (1983) Postoperative cesarean section morbidity: a prospective study. Am J Obstet Gynecol 146:911–916

    CAS  PubMed  Google Scholar 

  13. 13.

    Parker MC, Wilson MS, Menzies D et al (2004) Colorectal surgery: the risk and burden of adhesion-related complication. Colorectal Dis 6:506–511

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Alchalabi HA, Amarin ZO, Badria LF, Zayed FF (2007) Does the number of previous caesarean deliveries affect maternal outcome and complication rates? East Mediterr Health J 13:544–550

    CAS  PubMed  Google Scholar 

  15. 15.

    Gastmeier P, Sohr D, Breier A, Behnke M, Geffers C (2011) Prolonged duration of operation: an indicator of complicated surgery or of surgical (mis)management? Infection 39(3):211–215

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Hawrylyshyn PA, Bernstein P, Papsin FR (1981) Risk factors associated with infection following cesarean section. Am J Obstet Gynecol 139:294–298

    CAS  PubMed  Google Scholar 

  17. 17.

    Myles DT, Gooch J (2002) Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 100(5):959–964

    PubMed  Article  Google Scholar 

  18. 18.

    Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y (2011) Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet 283(4):735–741

    PubMed  Article  Google Scholar 

  19. 19.

    Gedikbasi A, Akyol A, Asar E, Bingol B, Uncu R, Sargin A, Ceylan Y (2008) Re-laparotomy after cesarean section: operative complications in surgical delivery. Arch Gynecol Obstet 278(5):419–425

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

The authors report no conflict of interest.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yariv Yogev.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ashwal, E., Yogev, Y., Melamed, N. et al. Characterizing the need for re-laparotomy during puerperium after cesarean section. Arch Gynecol Obstet 290, 35–39 (2014). https://doi.org/10.1007/s00404-014-3156-1

Download citation

Keywords

  • Re-laparotomy
  • Cesarean section
  • Puerperium