Hendin Natav, Seidman Liron, Geron Yossi, Zeevi Gil, Hadar Eran, Walfisch Asnat, Houri Ohad
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
Faculty of Medical and health Sciences, Tel Aviv University, Tel Aviv, Israel.
Int J Gynaecol Obstet. 2025 Mar;168(3):1154-1160. doi: 10.1002/ijgo.15979. Epub 2024 Oct 19.
To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters.
Retrospective case-control study conducted at a high-volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post-CD relaparotomy, compared with a control group that did not undergo a relaparotomy.
Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78-5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54-14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10-10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79-12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06-12.48, P < 0.01).
Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions.
识别并分析剖宫产术后再次剖腹手术相关的危险因素，重点关注产科和手术参数。
在一家高容量的三级产科中心进行回顾性病例对照研究。我们回顾了2013年至2023年间所有接受剖宫产的女性。需要再次剖腹手术（定义为筋膜重新打开）的患者被纳入研究组。系统回顾患者数据，以确定导致剖宫产术后再次剖腹手术需求的潜在危险因素，并与未接受再次剖腹手术的对照组进行比较。
在11465名接受剖宫产的女性中，59名（0.5%）需要再次剖腹手术。使用多变量模型分析独立危险因素，我们发现以下因素与再次剖腹手术相关：急诊剖宫产（调整后的比值比[aOR] 3.09，95%置信区间[CI] 1.78 - 5.38，P < 0.01）、前置胎盘（aOR 4.66，95% CI 1.54 - 14.11，P < 0.01）以及多胎妊娠作为剖宫产指征（aOR 4.61，95% CI 2.10 - 10.12，P < 0.01）；估计术中失血量超过1升（aOR 5.98，95% CI 2.79 - 12.80，P < 0.01）；以及术中粘连（aOR 7.12，95% CI 4.06 - 12.48，P < 0.01）。
我们的研究强调了剖宫产术后再次剖腹手术的多因素性质，强调了考虑一系列广泛危险因素的重要性。通过识别和理解这些因素，临床医生可以优化患者护理，并可能降低发病率，特别是减少后续手术干预的需求。
