Relaprotomy after caesarean section: An event of near miss maternal mortality.

Abstract

Objective: To find out risk factors, indications, causes, maternal mortality and morbidity after relaprotomy following caesarean section. Study Design: Descriptive (Cross Sectional) study. Setting: Department of Gynae, Mardan Medical Complex. Period: March 2015 to February 2020. Material & Methods: All women of any age or parity who had undergone caesarean section for any indication, which was followed by a relaprotomy, within a 60 days time period, irrespective of the location of the primary surgery, was included. Decision for relaprotomy was taken by the consultant in charge. All the data was entered in a predesigned proforma. Results: The rate of relaprotomy was 0.25%. Majority (88%) was in 20-35 years age group. 16 (61%)  Patients were multigravidas and 8(31%) were primigravidas. Most (84.6%) of the cases were unbooked. 8(31%) patients were referred from remote areas and private centres, where caesareans had already taken place. Placental abruption was the most common indication (34.6%), followed by previous scars (19%) and placenta previa (15%). Mean interval between primary surgery and relaprotomy was 13.5 + 3.2 hours. Indication for relaprotomy was Postpartum and intraperitoneal haemmorhage in 34.6% cases each followed by rectus sheath and broad ligament hematoma in 7.7% cases each.84.6% patients were admitted in ICU, 65.4% received massive blood transfusions, whereas 30.7% developed DIC and febrile morbidity and renal impairment was seen in 19% cases. The mortality rate was 15.38% and all of them were referred cases. Conclusion: Relaprotomy after caesarean section is a very high risk situation. Postoperative vigilance, timely intervention and efficient referral system can reduce both maternal mortality and morbidity.