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Relaparotomy post-cesarean delivery: characteristics and risk factors

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Relaparotomy following cesarean delivery (CD) is performed at a rate of 0.2–1% of CD. The objective of the present study was to identify risk factors for relaparotomy following CD, and to examine whether there is a difference in the risk of relaparotomy between CD performed during different hours of the day.

Methods

A retrospective study on all CD over 10 years compared pregnancies that underwent laparotomy within 1 week following CD to those that did not.

Results

Sixty-four patients underwent relaparotomy out of 24,239 CDs (0.26%). In univariate analysis, relaparotomy was significantly associated with pregnancies following assisted-reproductive-technologies odds ratio (OR) 95% confidence interval (CI) 3.15 (1.90–5.22), hypertensive disorders of pregnancy OR 3.05 (1.62–5.72), twin pregnancies OR 95% CI 3.78 (2.21–6.48), preterm deliveries OR 95% CI 2.44 (1.46–4.10), placenta previa OR 95% CI 6.41(2.55–16.09) and urgent CD 1.74 (1.06–2.86), especially during the second-stage of labor OR 95% CI 2.73 (1.34–5.54). The time of day of CD did not influence the rate of relaparotomy. In a multivariable-regression analysis, the adjusted odds ratio for relaparotomy was 10.24 in CD due to placenta previa, and 5.28 in CD performed at the second-stage of delivery.

At relaparotomy, active bleeding was found in 50 patients (78.1%), nearly half received packed cells, 12.5% developed consumptive coagulopathy, and 17.2% needed hospitalization in the intensive care unit. 6.3% underwent a second relaparotomy, mainly due to bleeding.

Conclusion

Placenta previa, and urgent CDs mainly those performed at the second stage of labor are risk factors for relaparotomy after CD.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

No funding was given for this study.

Author information

Author notes

  1. Weissmann-Brenner Alina and Barzilay Eran equally contributed to the manuscript.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Department of Neonatology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel

    Alina Weissmann-Brenner, Eran Barzilay, Raanan Meyer, Amal Alakeli, Noam Domniz & Israel Yoles

  2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Alina Weissmann-Brenner, Eran Barzilay, Raanan Meyer, Danielle Harmatz, Amal Alakeli, Noam Domniz & Israel Yoles

  3. The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Gabriel Levin

Authors
  1. Alina Weissmann-Brenner
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  2. Eran Barzilay
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  3. Raanan Meyer
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  4. Gabriel Levin
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  5. Danielle Harmatz
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  6. Amal Alakeli
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  7. Noam Domniz
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  8. Israel Yoles
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Contributions

W-BA: conception, planning, carrying out, analysing and writing, BE: conception, planning, carrying out, analysing and writing, MR: carrying out, analyzing, LGa: carrying out, analyzing, HD: carrying out, AA: carrying out, DN: carrying out and YI: conception.

Corresponding author

Correspondence to Alina Weissmann-Brenner.

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Conflict of interest

All the authors have made substantial contributions to the concept, data interpretation, drafting or critical revision of the manuscript for intellectual content and have approved the final version. There are no conflicts of interest for the authors.

Ethical approval

The study was approved by the IRB board of the Chaim Sheba Medical center No. 7223–20-SMC.

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Weissmann-Brenner, A., Barzilay, E., Meyer, R. et al. Relaparotomy post-cesarean delivery: characteristics and risk factors. Arch Gynecol Obstet 304, 1427–1432 (2021). https://doi.org/10.1007/s00404-021-06060-4

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  • DOI: https://doi.org/10.1007/s00404-021-06060-4

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