Relaparotomy Following Caesarean Section: A Cross Sectional Study

Delivery by caesarean section (CS) is the most common obstetric procedure in daily practice and rate is increasing worldwide. In spite of huge appeal for this operation, there is significant rate of short & long term complications. Relaparotomy after caesarean section in early post-operative period is one of the rarest short term complications but the fatality rate is very high. The objective of this study was to find out indications, managements, risk factors and outcomes of patients undergoing relaparotomy after CS. Finally to improve the quality of care for preventing this dreadful complication and to reduce the maternal mortality and morbidity. Purposive sampling was done, all consecutive patients who underwent relaparotomy within 6 weeks of CS in Rajshahi Medical College Hospital (RMCH) during study period from January 2015 to December 2015 has been included for this study. This was a cross-sectional and observational study in a tertiary referral and teaching hospital RMCH. During study period total admitted obstetric patients at RMCH were 12688. There were 9802 deliveries where 53.89% (n=5282) had vaginal delivery and 46.11% (n=4520) underwent caesarean sections. Among these 46.11% (n=4520) CS, relaparotomy was needed 0.18% (n=8) cases. Total relaparotomy was done in 0.39% (n=50) cases out of 12688 obstetric patients. Out of 50 cases 42 had caesarean delivery in other hospitals and clinics outside RMCH. The indications of relaparotomy were secondary post-partum hemorrhage (PPH) 28% (n=14), primary PPH 12% (n=6), haemoperitoneum 22% (n=11), pyoperitoneum 18% (n=9), subrectal hematoma 16% (n=8) and burst abdomen 4% (n=2). Main surgeries performed were subtotal hysterectomy in 44% (n=22) cases, total abdominal hysterectomy in 10% (n=5) cases, re-suturing of uterine incision 8% (n=4), drainage of pus & peritoneal toileting 8% (n=4), ligation of bleeding vessels 6% (n=3), drainage of subrectalhaematoma in 16% (n=8) cases, repair of intestinal injury 4% (n=2) and repair of anterior abdominal wall in 4% (n=2) cases. Case fatality of relaparotomy was high 18% (n=9), majority were preventable. Identification of risk factors, adequate attention, expert decision, prompt intervention & proper management will improve the outcome.