Re-laparotomy following cesarean delivery – risk factors and outcomes

Levitt, L.; Sapir, Hana; Kabiri, Doron; Ein-Mor, Eliana; Hochner‐Celnikier, Drorith; Amsalem, Hagai

doi:10.3109/14767058.2015.1012065

Cited by 12 publications

(11 citation statements)

References 6 publications

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“…Rates of composite adverse maternal outcome according to number of CD performed and supervised by an attending obstetrician. 32 The rates of maternal complications of the CDs that are reported in this study are consistent with previous major publications: urinary and gastrointestinal tract injuries (0.18e0.48%), 24 blood transfusion (3.2%), 33 relaparotomy (0.23e0.4%), [34][35][36] readmission to hospital (1.8%), 23 and a composite of selected maternal adverse outcomes (19.6-21.7%). 24 Our study strengths include the large number of CDs and consistent method of real time data collection that was gleaned from electronic medical record.…”

Section: Composite Adverse Maternal Outcome By Obstetrician Annual Cesupporting

confidence: 90%

Impact of surgeon annual volume on short-term maternal outcome in cesarean delivery

Drukker

Hants

Farkash

et al. 2016

American Journal of Obstetrics and Gynecology

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Section: Composite Adverse Maternal Outcome By Obstetrician Annual Cesupporting

confidence: 90%

Impact of surgeon annual volume on short-term maternal outcome in cesarean delivery

Drukker

Hants

Farkash

et al. 2016

American Journal of Obstetrics and Gynecology

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“…31 Furthermore, it seems that major obstetric hemorrhage occurs more frequently in women operated by junior as compared to senior obstetricians (19.6%, 164/835 vs. 13.1%, 153/1166). 32 The rates of maternal complications of CD reported in this study are consistent with previous major publications: urinary and gastrointestinal tract injuries 0.18-0.48%, 24 blood transfusion 3.2%, 33 re-laparotomy 0.23-0.4%, [34][35][36] readmission to hospital 1.8%, 23 and a composite of selected maternal adverse outcomes 19.6-21.7%. 24…”

Section: Commentsupporting

confidence: 89%

Impact of Surgeon Annual Volume on Short-term Maternal Outcome in Cesarean Delivery

Drukker¹,

Hants²,

Farkash³

et al. 2017

Obstetric Anesthesia Digest

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Background: The annual procedure volume is an accepted marker for quality of care and has been documented in various medical fields. Surgeon volume has been shown to correlate with morbidity and mortality in surgical and high risk medical procedures. Though cesarean delivery is one of the most common surgical procedures in the USA, the link between surgeon's annual cesarean delivery volume and maternal outcome has never been tested. Objective: To evaluate the impact of surgeons' annual volume on short term maternal outcome in cesarean deliveries. Study Design: Retrospective cohort study in a single tertiary center between 2006 and 2013. Cesarean deliveries were categorized into two groups based on the annual volume of cesarean delivery of the attending obstetrician. LOW group included low annual volume obstetricians, whose annual volume of cesarean delivery was lower than median. HIGH group comprised high annual volume obstetricians whose annual volume was median and above. Data were collected for all cesarean deliveries; stillbirth and cesarean hysterectomy were excluded. Further analyses were done for quartiles and for four clinical relevant groups according to the annual number of cesarean delivery performed/supervised by the attending (20 or less, 21-60 , 61-120 and more than 120) in regards to the primary outcome. Data were collected for all cesarean deliveries; stillbirth and cesarean hysterectomy were excluded. The primary outcome was a composite adverse maternal outcome including one or more of the following: urinary or gastrointestinal tract injuries, hemoglobin drop > three gm/dL, blood transfusion, re-laparotomy, puerperal fever, prolonged maternal hospitalization and readmission. Secondary outcomes were operative times (skin incision to delivery and overall). Results: A total of 11,954 cesarean deliveries were included, the median annual number of cesarean delivery performed/supervised performed by one obstetrician was 48. Unadjusted bivariate analysis suggested that HIGH group patients, had fewer urinary and gastrointestinal 5

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“…The rate of laparotomy after cesarean section in women with SAMM in the Netherlands (0.3%) appears relatively low compared to the literature (0.2-0.9%) [ 2 – 11 ]. Since laparotomy after vaginal birth has not been studied before, the incidence we found for laparotomy following vaginal birth cannot be compared to other studies.…”

Section: Discussionmentioning

confidence: 79%

“…Previous studies only address ‘re-laparotomy’ after cesarean section. Reported incidence rates of ‘re-laparotomy’ are low, varying between 0.2 and 0.9% [ 2 – 11 ]. Although data on laparotomy after vaginal birth are not reported, it has been suggested that the incidence of laparotomy may be higher after cesarean section, since operative birth is associated with a higher risk of maternal morbidity and mortality [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Laparotomy in women with severe acute maternal morbidity: secondary analysis of a nationwide cohort study

Witteveen

Kallianidis

Zwart

et al. 2018

BMC Pregnancy Childbirth

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BackgroundAlthough pregnancy-related laparotomy is a major intervention, literature is limited to small case-control or single center studies. We aimed to identify national incidence rates for postpartum laparotomy related to severe acute maternal morbidity (SAMM) in a high-income country and test the hypothesis that risk of postpartum laparotomy differs by mode of birth.MethodsIn a population-based cohort study in all 98 hospitals with a maternity unit in the Netherlands, pregnant women with SAMM according to specified disease and management criteria were included from 01/08/2004 to 01/08/2006. We calculated the incidence of postpartum laparotomy after vaginal and cesarean births. Laparotomies were analyzed in relation to mode of birth using all births in the country as reference. Relative risks (RR) were calculated for laparotomy following emergency and planned cesarean section compared to vaginal birth, excluding laparotomies following births before 24 weeks’ gestation and hysterectomies performed during cesarean section.ResultsThe incidence of postpartum laparotomy in women with SAMM in the Netherlands was 6.0 per 10,000 births. Incidence was 30.1 and 1.8 per 10,000 following cesarean and vaginal birth respectively. Compared to vaginal birth, RR of laparotomy after cesarean birth was 16.7 (95% confidence interval [95% CI] 12.2-22.6). RR was 21.8 (95% CI 15.8-30.2) for emergency and 10.5 (95% CI 7.1-15.6) for planned cesarean section.ConclusionsRisk of laparotomy, although small, was considerably elevated in women who gave birth by cesarean section. This should be considered in counseling and clinical decision making.

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Re-laparotomy following cesarean delivery – risk factors and outcomes

Cited by 12 publications

References 6 publications

Impact of surgeon annual volume on short-term maternal outcome in cesarean delivery

Impact of surgeon annual volume on short-term maternal outcome in cesarean delivery

Impact of Surgeon Annual Volume on Short-term Maternal Outcome in Cesarean Delivery

Laparotomy in women with severe acute maternal morbidity: secondary analysis of a nationwide cohort study

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