ANALYSIS OF EARLY RELAPAROTOMY IN OBSTETRIC GYNAECOLOGICAL SURGERIES

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 intraabdominal bleed-ing in 24 (63.2%), uncontrolled postpartum haemorr-hage (PPH) in nine (23.7%) and suspected abdominal wall bleeding in five (13.15%) cases. Major risk factor in gynaecological cases was evacuation and curettage (55.5%). In obstetric patients risk factor was previous 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 developed complications. There were three (7.9%) maternal deaths following relaparotomy. Conclusion: Intraabdominal bleeding is main cause for re-operation 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.