Risk factors for relaparotomy after cesarean delivery

Objective: To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters.

Methods: Retrospective case-control study conducted at a high-volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post-CD relaparotomy, compared with a control group that did not undergo a relaparotomy.

Results: Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78-5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54-14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10-10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79-12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06-12.48, P < 0.01).

Conclusions: Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions.