ANALYSIS OF EARLY RELAPAROTOMY IN OBSTETRIC & GYNAECOLOGICAL SURGERIES

Abstract

Abstract

Objectives:  Evaluation of risk factors, frequency, causes and measures took to save patients’ life in relaparotomies.

Methods:  This retrospective, descriptive study was conducted from January 2012 – December 2014 in a tertiary care hospital.

Results:  This study includes 38 cases, 29 (76.3%) obstetrical and nine (23.7%) gynaecological Relaparotomy incidence was 0.43%. It was 0.55% for obstetrical and 0.24% for gynaecological indications. The leading causes were suspected intra-abdominal bleeding in 24 (63.2%), uncontrolled postpartum haemorrhage (PPH) in nine (23.7%) and suspected abdominal caesarean sections (CS) 28/29(96.5%). Of 28 previous CS cases, multiple CS were in13 (46.4%), placenta previa in five (17.85%) and antepartum hemorrhage in four (14.28%) cases. Majority (92.1%) of patients underwent relaparotomy within 24 hours after primary surgery. Patients received (mean ± SD) 7.2 ± 5.4 packed red blood cells, 4.3 ± 5.5 fresh frozen plasma and 1.2 ± 2.3 platelets units. Third operation was needed in seven (18.4%) cases. Twelve (31.6%) women develo-ped complications. There were three (7.9%) maternal deaths following relaparotomy.

Conclusion:  Intra-abdominal bleeding is main cause for reoperation and multiple CS is major risk factor. Recognition of risk factors, careful primary operation, involvement of seniors in complicated surgeries and early intervention can prevent majority of the relaparotomies.

Key words:  Relaparotomy, reoperation, complicated caesarean section, maternal mortality, obstetrics and gynaecology, intra-peritoneal haemorrhage.