Obstetric relaparotomies: 13 years of tertiary care experience

INTRODUCTION: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality. Relaparotomy (RL) is the most serious complication after delivery (normal delivery or cesarean section). RL is very rarely required and mostly performed due to intra-abdominal bleeding. This study aims to show the indications for obstetric RL due to hemorrhage and reveal hemorrhage areas.
METHODS: A total of 120 patients with an RL history due to cesarean and vaginal postpartum hemorrhage were included in the study. Data such as age, gravida, parity, the procedure performed in an RL, the time between surgeries, complications, and the need for blood transfusion were obtained from clinical files. De-scriptive statistical analysis was performed.
RESULTS: The RL incidence was 0.44%. Of all RLs, 18.3% (n=22) occurred after vaginal delivery while 81.7% (n=98) occurred after cesarean sections. The indications for an RL were intra-abdominal hemorrhage (83.4%, n=100) and atony (16.6%, n=20). Surgical procedures during an RL were hysterectomy (37.5%, n=45), vascular ligation (19.1%, n=23), secondary suturing (24.1%, n=29), rectus muscle repair (13.3%, n=16), and uterine rupture repair (5.8%, n=7).
DISCUSSION AND CONCLUSION: Close follow-up of the patient after delivery is vital in terms of postpartum hemorrhage. The postpartum RL requirement is 0.44% and it is life-saving. Active management during this period is very significant in terms of reducing maternal morbidity and mortality.