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Licensed Unlicensed Requires Authentication Published by De Gruyter June 8, 2013

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

  • Shiri Shinar EMAIL logo , Mara Hareuveni , Ofira Ben-Tal and Ariel Many


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.

Corresponding author: Shiri Shinar, MD, 10 Hedera St, Apt 2, Tel Aviv, 62095, Israel, Tel.: +972-524262188

Special thanks to Prof. Edna Schechtman, Ben Gurion University of the Negev, for guidance and assistance in the statistical analysis. Special thanks to Esther Skornick for assisting in data collection.


[1] Kessous R, Danor D, Weintraub YA, Wiznitzer A, Sergienko R, Ohel I, et al. Risk factors for relaparotomy after cesarean section. J Matern Fetal Neonatal Med. 2012;25:2167–70.10.3109/14767058.2012.668978Search in Google Scholar

[2] Kim JM, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, et al. Analysis of risk factors for postoperative morbidity in perforated peptic ulcer. J Gastric Cancer. 2012;12:26–35.10.5230/jgc.2012.12.1.26Search in Google Scholar

[3] Koslowsky M, Babkoff H. Meta-analysis of the relationship between total sleep deprivation and performance. Chronobiol Int. 1992;9:132–6.10.3109/07420529209064524Search in Google Scholar

[4] Lurie S, Sadan O, Golan A. Re-laparotomy after cesarean section. Eur J Obstet Gynecol Reprod Biol. 2007;134:184–7.10.1016/j.ejogrb.2006.10.017Search in Google Scholar

[5] Malabarey O, Almog B, Brown R, Abenhaim HA, Shrim A. Postpartum hemorrhage in low risk population. J Perinat Med. 2011;39:495–8.10.1515/jpm.2011.059Search in Google Scholar

[6] Martínez-Casas I, Sancho JJ, Nve E, Pons MJ, Membrilla E, Grande L. Preoperative risk factors for mortality after relaparotomy: analysis of 254 patients. Langenbecks Arch Surg. 2010;395:527–34.10.1007/s00423-009-0538-0Search in Google Scholar

[7] McCormick ML, Sanghvi HC, Kinzie B, McIntosh N. Preventing postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet. 1977;77:267–75.10.1016/S0020-7292(02)00020-6Search in Google Scholar

[8] Menacker F, Hamilton BE. Recent trends in cesarean delivery in the United States. NCHS Data Brief. 2010;35:1–8.Search in Google Scholar

[9] Nisenblat V, Barak S, Griness OB, Degani S, Ohel G, Gonen R. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol. 2006;108:21–6.10.1097/01.AOG.0000222380.11069.11Search in Google Scholar PubMed

[10] Seal SL, Kamilya G, Bhattacharyya SK, Mukherji J, Bhattacharyya AR. Relaparotomy after cesarean delivery: experience from an Indian teaching hospital. J Obstet Gynaecol Res. 2007;33:804–9.10.1111/j.1447-0756.2007.00660.xSearch in Google Scholar PubMed

[11] Seffah JD. Re-laparotomy after Cesarean section. Int J Gynaecol Obstet. 2005;88:253–7.10.1016/j.ijgo.2004.12.014Search in Google Scholar PubMed

[12] Sturm L, Dawson D, Vaughan R, Hewett P, Hill AG, Graham JC, et al. Effects of fatigue on surgeon performance and surgical outcomes: a systematic review. ANZ J Surg. 2011;81: 502–9.10.1111/j.1445-2197.2010.05642.xSearch in Google Scholar

[13] Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980–85 rise. Am J Public Health. 1987;77:955–9.10.2105/AJPH.77.8.955Search in Google Scholar

[14] Turner RJ, Lambrost M, Holmes C, Katz SG, Downs CS, Collins DW, et al. The effects of sevoflurane on isolated gravid human myometrium. Anaesth Intensive Care. 2002;30:591–6.10.1177/0310057X0203000508Search in Google Scholar

[15] van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol. 1997;74:1–6.10.1016/S0301-2115(97)02725-5Search in Google Scholar

[16] Wolfe HM, Gross TL, Sokol RJ, Bottoms SF, Thompson KL. Determinants of morbidity in obese women delivered by cesarean. Obstet Gynecol. 1988;71:691–6.10.1097/00132582-198810000-00003Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2012-12-1
Accepted: 2013-4-15
Published Online: 2013-06-08
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

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