Relaparotomies after cesarean sections: risk factors, indications, and management.

Objective: To establish the frequency of post-cesarean relaparotomy, identify its risk factors, indications, and operative management.
Methods: This study was a retrospective matched case control study. Records of all women who underwent a cesarean section (CS) from July 2006 to March 2012 were reviewed. We identified all women who had a relaparotomy within 1 month from their CS. For each woman, two women were matched. We analyzed data regarding obstetrical history, current gestation, surgical parameters, and outcome.
Results: A total of 14,637 CS were performed during this period, of these, 58 cases required a relaparotomy (0.4%). In univariate analysis, female sex and duration of CS were associated with an increased risk for relaparotomy. In multivariate analysis, multiple pregnancies, general anesthesia, duration of operation, and female sex, independently increased the risk for relaparotomy. The leading indications for relaparotomy were hemodynamic shock and subcutaneous hematoma. The most common interventions during relaparotomy were cauterization of subcutaneous vessels, and ligation of large vessels. Overall, women requiring relaparotomy received, on average, 16 units of blood products.
Conclusions: This study highlights risk factors associated with post-cesarean relaparotomy. Surgeons might use this important data to identify women at risk beforehand, and thus, reduce the morbidity associated with relaparotomy.