Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petah Tiqwa, Israel.
Arch Gynecol Obstet. 2014 Jul;290(1):35-9. doi: 10.1007/s00404-014-3156-1. Epub 2014 Feb 1.
As inconsistency exists concerning the rate and risk factors for re-laparotomy after cesarean section (CS), we aimed to determine the incidence, risk factors and indications for re-laparotomy after CS.
This is a retrospective study. Women underwent re-laparotomy following CS were compared to a control group in a 1:3 ratio. Demographic, obstetrical and surgical data were analyzed. CS complications were defined as intra-operative abnormal hemorrhage, summoning surgical personnel, inverted T incision, uterine and/or hypogastric arteries ligation or cesarean hysterectomy.
Overall, 35,779 women delivered during the study, of them 7,926 by CS (22.1 %) and 62 patients (0.7 %) underwent re-laparotomy. Re-laparotomies occur during the first 24 h, first week and beyond it, following CS in 64.5, 22.6 and 12.9 %, respectively. Previous abdominal/pelvic surgery (14.5 vs. 8.1 %, p < 0.01), emergent surgery (24.2 vs. 13.4 %, p = 0.04), intra-operative complications (26.8 vs. 0.5 %, p < 0.001), post-operative complication (40.7 vs. 0.5 %, p < 0.001) and adhesions (65.5 vs. 33.3 %, p < 0.001) were significantly increased in the study group. Indications for re-laparotomy varied according to the interval elapsed to the re-laparotomy with post-partum hemorrhage (27.4 %) being the leading indication in the early period.
Risk factors for re-laparotomy following CS can be recognized and are mainly associated with previous abdominal and/or pelvic surgeries and intra-operative adhesions.
由于剖宫产术后再次剖腹手术的发生率和风险因素存在差异，我们旨在确定剖宫产术后再次剖腹手术的发生率、风险因素和适应证。
这是一项回顾性研究。将行剖宫产术后再次剖腹手术的妇女与对照组按 1:3 的比例进行比较。分析人口统计学、产科和手术数据。剖宫产术并发症定义为术中异常出血、召集手术人员、倒置 T 切口、子宫和/或下腹动脉结扎或子宫切除术。
在研究期间，共有 35779 名妇女分娩，其中 7926 名经剖宫产术分娩（22.1%），62 名患者（0.7%）行再次剖腹手术。再次剖腹手术发生在 CS 后 24 小时内、第一周和第一周后，分别占 64.5%、22.6%和 12.9%。既往腹部/盆腔手术（14.5%比 8.1%，p<0.01）、急诊手术（24.2%比 13.4%，p=0.04）、术中并发症（26.8%比 0.5%，p<0.001）、术后并发症（40.7%比 0.5%，p<0.001）和粘连（65.5%比 33.3%，p<0.001）在研究组中显著增加。再次剖腹手术的适应证因再次剖腹手术与产后出血之间的间隔时间而异，早期以产后出血（27.4%）为主要适应证。
剖宫产术后再次剖腹手术的风险因素可被识别，主要与既往腹部和/或盆腔手术及术中粘连有关。
