Relaparotomy post-cesarean delivery: characteristics and risk factors

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.