Shan Dan, Han Jinbiao, Tan Xi, Yu Pingjing, Cai Yitong, Yi Ke
Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, No. 20, Renmin South Road, Section 3, 610041, Chengdu, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
BMC Pregnancy Childbirth. 2025 Mar 11;25(1):269. doi: 10.1186/s12884-025-07365-x.
The high prevalence of caesarean section (CS) is a global concern. Relaparotomy is needed when conservative managements are not effective in CS complications. This study aimed to systematically review and meta-analyze the mortality rate and risk factors of relaparotomy after CS.
Based on a pre-registered protocol, we searched 11 databases. The MOOSE guideline was followed, and the reporting was in accordance with the PRISMA statement. A Freeman-Tukey double arcsine transformation was used to transform the raw data, and a random-effects meta-analytic model was applied. The quality of the evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
The qualities of the pooled results were assessed to be "very low" based on the inclusion of observational studies. A total of 40 studies were retrieved. The mortality rate in patients after relaparotomy was 7.24% (95%CI 4.10-11.03%). Significant gap existed between high-resources and low-resources countries. In developed areas this rate was 0.56% and in places of low resources this rate was 16.90%. Higher CS rate correlated with higher mortality. Over 70% of the relaparotomies followed emergent CS. Risk factors associated with relaparotomy included higher maternal age, CS performed in the second stage of labor, twin pregnancy, preterm birth (OR 2.72, 95%CI 1.87-3.95) and preeclampsia (OR 3.24, 95%CI 1.47-7.14).
Our findings demonstrated the high mortality rate in patients who had relaparotomy after CS. Interpretation of the results should be with caution due to GRADE evidence level. During a time when there is an imbalance in medical resources in different countries, interventions to reduce CS rate, good prenatal care and intensified post-operative management are important.
PROSPEROCRD42021265325.
剖宫产（CS）的高发生率是一个全球关注的问题。当保守治疗对剖宫产并发症无效时，需要再次剖腹手术。本研究旨在系统评价和荟萃分析剖宫产术后再次剖腹手术的死亡率及危险因素。
根据预先注册的方案，我们检索了11个数据库。遵循MOOSE指南，并按照PRISMA声明进行报告。使用Freeman-Tukey双反正弦变换对原始数据进行变换，并应用随机效应荟萃分析模型。采用推荐分级评估、制定和评价（GRADE）方法评估证据质量。
基于纳入观察性研究，汇总结果的质量被评估为“极低”。共检索到40项研究。再次剖腹手术后患者的死亡率为7.24%（95%CI 4.10-11.03%）。高资源国家和低资源国家之间存在显著差距。在发达地区，这一比率为0.56%，在资源匮乏地区，这一比率为16.90%。较高的剖宫产率与较高的死亡率相关。超过70%的再次剖腹手术发生在急诊剖宫产之后。与再次剖腹手术相关的危险因素包括产妇年龄较大、在第二产程进行剖宫产、双胎妊娠、早产（OR 2.72，95%CI 1.87-3.95）和子痫前期（OR 3.24，95%CI 1.47-7.14）。
我们的研究结果表明，剖宫产术后再次剖腹手术的患者死亡率较高。由于GRADE证据水平，对结果的解释应谨慎。在不同国家医疗资源不均衡的时期，降低剖宫产率的干预措施、良好的产前护理和强化的术后管理很重要。
PROSPERO CRD42021265325。
