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Arch Gynecol Obstet. 2014 Jul;290(1):35-9. doi: 10.1007/s00404-014-3156-1. Epub 2014 Feb 1.

Characterizing the need for re-laparotomy during puerperium after cesarean section.

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Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petah Tiqwa, Israel.



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.

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