The following is a summary of “Risk factors for relaparotomy after a cesarean delivery: a case-control study,” published in the April 2024 issue of Obstetrics and Gynecology by Amikam et al.
Relaparotomy subsequent to cesarean delivery (CD) represents a relatively rare yet impactful occurrence characterized by varied risk factors and indications. This study sought to delineate these factors and indications within the context of a comprehensive investigation conducted at a large tertiary center.
Conducted as a retrospective case-control study spanning from 2013 to 2023, this research scrutinized data from a single institution. The study cohort encompassed women who underwent relaparotomy within six weeks post-CD (the study group), juxtaposed against a control cohort at a 1:2 ratio. Controls comprised CD recipients immediately before and after each case in the study group, yet exempt from relaparotomy. Inclusion criteria encompassed CDs post-24 gestational weeks, excluding surgeries conducted at other facilities and those necessitated by unrelated post-CD issues (e.g., appendicitis). Logistic regression was employed to control for potential confounding variables.
Among 131,268 deliveries during the study period, 28,280 (21.5%) involved CD, with 130 (0.46%) necessitating relaparotomy. Instances of relaparotomy following CD manifested predominantly within 24 hours (59.2%), within the first week (33.1%), and beyond (7.7%). Multivariable logistic regression unveiled significant associations between relaparotomy and various factors, including Mullerian anomalies (aOR 3.33), uterine fibroids (aOR 3.17), multiple pregnancies (aOR 4.1), hypertensive disorders of pregnancy (aOR 3.46), CD during the second stage of labor (aOR 2.54), complications during CD (aOR 1.62), and excessive bleeding during CD or implementation of hemostatic measures (aOR 2.23). Notably, the leading indication for relaparotomy within the initial 24 hours was suspected intra-abdominal bleeding (36.1%).
This study delineates a spectrum of pregnancy, intrapartum, and intraoperative factors predisposing to relaparotomy post-CD. By elucidating these risk factors and indications, healthcare practitioners can proactively identify and manage at-risk individuals, potentially mitigating associated morbidity.
Source: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06455-6