Indication and outcome of relaparotomy after caesarean section

Abstract

The

Relaparotomy: review of indications and outcome in tertiary care hospital

“…Hemorrhage was in the form of PPH (56.36%) followed by rectus sheath hematoma (14.55%) and intraperitoneal hemorrhage (12.73%). 3 Study by Levin I et al showed major cause of relaparotomy to be intra-abdominal bleeding (50%) followed by uncontrolled post-partum hemorrhage (35.7%), bowel injury or infection (10.7%) , and abdominal wall bleeding (3.6%). 4 In study by Seal SL et al post-partum hemorrhage (42.4%) and rectus sheath hematoma (27.3%) were the leading causes for relaparotomy.…”

“…7 Bleeding points on under surface of rectus sheath should always be checked and secured to prevent rectus sheath hematoma. 3 In case of cesarean section bleeding may be present along uterine incision especially at uterine angles due to loose knot or loose sutures. Proper hemostasis during repair of uterine incision should be achieved.…”

“…1 In cases with placenta previa, proper hemostasis of placental bed is to be ensured before closing the uterine incision. 3 A careful surgical approach keeping in mind these practices could help to reduce the incidence of relaparotomy due to hemorrhage.…”

“…Out of total 55 patients requiring relaparotomy after cesarean section in study by Biswas SP et al , 40% patients had cesarean section in view of prolong labor and fetal distress, 10.91% for hypertensive disorders of pregnancy, 10.9% for previous one or more cesarean sections, 9.09% of patients each for obstructed labor and placenta previa, 5.45% for post cesarean placenta previa. 3 Levin I et al showed indication of initial surgery to be non-reassuring fetal heart rate in 25%, pregnancy induced hypertension in 14.3%, arrest of descent or dilatation or both in 28.6% and placental abruption in 17.9%. 4 In study by Ahmed Khan NB et al indication of cesarean section in patients undergoing relaparotomy was non progress of labor in 29.63%, fetal distress in 22.22%, previous cesarean section in 22.22%, placenta previa in 14.81%, failed induction in 7.4% and placental abruption in 3.75%.…”

“…In study by SP Biswas et al 39 out of 55 patients had surgery for emergency indications. 3 In study by Ahmed Khan NB et al 85.19% patients were operated for emergency indications. 6 Lately cesarean section rate has increased considerably due to early diagnosis of fetal distress, medico legal implications, better anesthetic facilities and availability of blood and expert care, and increased compliance of health care personnel to cesarean section on demand by patients.…”