Analysis of Different Factors Associated with Re-Laparotomy after Cesarean Section Deliveries at a Tertiary Care Hospital

Abstract

Objective: To evaluate the risk factors associated with re-laparotomy after cesarean section.

Study Design: Prospective case-controlled Analysis

Place and Duration of Study: This study was conducted at the Gynecology department of Nishtar Medical University & Hospital Multan from Aug 2020 to Jan 2021 for a period of six months.

Materials and Methods: The study involved all the cases who underwent re-laparotomy after a cesarean section. The study cases were matched with control subjects who underwent cesarean section without re-laparotomy after cesarean. The study participants were compared for demographic information, obstetric clinical data, and indications of the cesarean section.

Results: Out of a total of 837 cesarean section deliveries conducted in the hospital within the study period, 19 (2.2%) underwent exploratory re- laparotomy. The average time between primary surgical procedure and re-laparotomy was 1.2 ± 0.5 days. Postpartum hemorrhage (PPH) was the major indication of re-laparotomy reported in 12 (63.1%) women. The leading indications of cesarean section were multiple prior cesareans (18, 31%), fetal distress (9, 15.5%), placental previa (7, 12%), and placental abruption (6, 10.3%). Upon multivariate logistic regression, Placenta previa (OR 5.97; CI 0.96- 21.3), fetal macrosomia (OR 5.61; CI 0.91-23.1), and pre-Eclampsia were found to be significant risk factors of re-laparotomy.

Conclusion: In the present study, re-laparotomy was conducted in 2.2% of cases during the study period. Placenta previa, fetal macrosomia, and pre-Eclampsia were the strongest risk factors causing re-laparotomy after cesarean section.