Exploring the risk factors for relaparotomy following cesarean delivery

Cesarean delivery (CD) is the most common obstetrical surgery with increasing rates worldwide. Although considered relatively safe, intra- and post-operative complications have been reported. One rare, but significant, complication after CD is relaparotomy. The present study was conducted to define risk factors for relaparotomy following a CD.

A case-control study was conducted comparing all singleton CD that occurred in a tertiary medical center between the years 1991 and 2021. CDs complicated by relaparotomy (defined as the reopening of the fascia) were compared with CDs that were not complicated by relaparotomy. Generalized estimation equation (GEE) models were constructed to control for confounding variables.

During the study period, 49,922 CDs met our inclusion criteria, of them, 97 (0.2%) had undergone relaparotomy. The group of women complicated with relaparotomy tended to be multiparous and to have undergone a previous CD. Furthermore, these women had higher rates of placental complications (placenta previa, abruption and placenta accreta), preterm delivery, preeclampsia and chorioamnionitis. They also had higher rates of cervical tears and post-partum hemorrhage. Their neonates had lower birth weight and lower 5 min Apgar scores. In a GEE model, several independent risk factors for relaparotomy following CD were noted, with cervical tear being the most prominent (adjusted OR = 27.15, 95%CI 9.32 - 79.13, p < 0.001).

Independent risk factors for relaparotomy following CD include cervical tear, placenta previa and accreta, placental abruption, preterm delivery, preeclampsia, and a previous CD. These risk factors should be taken into account when dealing with high-risk patients expected to undergo repeated CD.