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Q&A

Operative Obstetrics

Poster Session 4

(925) Risk Factors for the Need for Repeated Surgical Intervention After a Cesarean Delivery

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Uri Amikam, MD (he/him/his)

MFM fellow
McGill University
Westmount, QC, Canada

Coauthor(s)

YB

Yael Botkovsky, BSc

Tel-Aviv University
Tel-Aviv, Israel, Israel
alyssa Hochberg, MD, MPH

Alyssa Hochberg MD MPH
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
Petach Tikva, Israel, HaMerkaz, Israel
AC

Aviad Cohen, MD

Lis Hospital for Women's Health, Sourasky Medical Center, Tel Aviv, Israel
Tel-Aviv, Israel, Israel
IL

Ishai Levin, MD

Lis Hospital for Women's Health, Sourasky Medical Center, Tel Aviv, Israel
Tel-Aviv, Israel, Israel
YY

Yariv Yogev, MD

Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center
Tel Aviv, Israel, Israel
Liran Hiersch, MD, PhD

MFM specialist
Sourasky Medical Center
Tel-Aviv, Israel, Israel
AL

Anat Lavie, MD

Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center
Tel-Aviv, Israel, Israel

Objective: To determine risk factors for re-surgery following a cesarean delivery (CD).

Study Design: A retrospective case-control study at a single tertiary university-affiliated medical center (2013-2023). Women who had a repeat surgery up to 6 weeks of the CD (re-surgery group) were compared to a control group of women with a CD without re-surgery in a 1:2 ratio. Controls were women who had a CD before and after each case in the re-surgery group. Maternal characteristics, obstetrical and surgical data were compared. Inclusion criteria were CD occurring ≥24 gestational weeks and opening of the fascia at the repeat surgery. CD performed at different centers and indications for repeat surgery unrelated to the primary surgery (appendicitis, etc.) were excluded. Logistic regression was used to adjust for potential confounders.

Results: 1. Overall, 138,765 women delivered during the study period. Of them, 27,302 (19.7%) delivered by CD; and 101 (3.7/1,000) underwent re-surgery in the postpartum period.
2. 87/101 (86.2%) were operated by relaparotomy, and 14/101 (13.8%) by laparoscopy. The median time for re-operation was 27 hours (IQR 29-143 hours).
3. There were no significant differences between the groups regarding maternal age, body mass index, gravidity, parity, rate of previous CD, gestational diabetes mellitus, and gestational age at delivery (p > 0.05 for all).
4. There were significantly higher rates of multiple pregnancies (11.9% vs. 2.5%, p< 0.001), low molecular weight heparin (LMWH) use during pregnancy (9.9% vs. 2%,p=0.02), and hypertensive disorders of pregnancy (HDP) (13.9% vs. 4.5%,p=0.003) in the study compared to the control group.
5. In a multivariable logistic regression, multiple pregnancies, LMWH use, HDP, estimated blood loss at CD, and the use of a hemostatic dressing, were all found to be significant independent predictors of the need for re-operation following CD (Table).

Conclusion: Several pregnancy and intra-operative risk factors can be identified for the need for re-surgery following a CD, requiring appropriate diligent care and management.