Closure versus non-closure of the visceral peritoneum (VP) in patients with gestational hypertension--an...

Caesarean section (CS) is one of the most frequently performed surgical procedures worldwide. Surgical variants include closure and non-closure of the peritoneum: in case of non-suturing the visceral peritoneum (VP), abnormal fluid collections such as blood clots may lead to formation of a hematoperitoneum.

In this retrospective, observational study we reviewed 1848 patients with gestational hypertension (GH) undergoing repeat and primary CS performed by non-closure of the visceral peritoneum (VP).

Six of these patients had major early post-CS complications: 5 patients experienced hypovolaemic shock that required urgent operative intervention. Four patients underwent repeat laparotomy and one patient was treated by laparoscopy.

As an early major post-CS complication, hematoperitoneum occurs in cases with poor haemostasis and/or with haemodynamic disorders such as GH. A decrease in blood pressure (BP) during CS caused by spinal/epidural anaesthesia and the following BP increase in GH patients may favour bleeding complications. Closure of the VP may facilitate early detection of a subperitoneal hematoma. In contrast, hematoperitoneum may develop in cases of non-closure of the VP followed by hypovolemic shock. Early and aggressive intervention results in excellent prognosis of this complication.