Relaparotomy after cesarean delivery: Experience from an Indian teaching hospital

Aim: Analysis of cases requiring relaparotomy following cesarean delivery (within 6 weeks of surgery). Methods: This was a retrospective observational study set in a teaching institution in Kolkata, India, of 66 cases requiring relaparotomy following cesarean delivery. Results: Over a period of 3 years from 1 January 2002 to 31 December 2004, 12 967 cesarean deliveries were done. During the same period, 66 cases had repeat laparotomy. Of these, 43 cases followed cesarean delivery at the institution itself, while 23 had had a cesarean delivery at a peripheral hospital. Post-partum hemorrhage in 28 cases (42.4%) and rectus sheath hematoma in 18 cases (27.3%) were the leading indications for relaparotomy. Of these 66 cases, 63 (95.5%) had intrapartum cesarean delivery, while three (4.5%) had an elective operation. Procedures undertaken at relaparotomy were resuturing of uterine incision in 22 cases (33.3%), uterine artery ligation in 19 cases (28.8%), and drainage of hematoma in 18 cases (27.3%). A third laparotomy was needed in 13 cases (19.6%), of which 11 were due to secondary post-partum hemorrhage. There were eight maternal deaths following relaparotomy. Conclusions: Repeat laparotomy within 6 weeks of cesarean delivery was required following 1 in 300 cases done in an Indian teaching hospital. The majority of these were preventable and could have been avoided if adequate attention had been paid at the time of the primary surgery.