A Ten Year Retrospective Analysis of Incidence, Categorization, Risk Factor and Outcome of Postpartum Laparotomy

BACKGROUND: According to the World Health Organization (WHO), laparotomy is a critical intervention required in the management of potentially life-threatening conditions, especially in the postpartum period. Tertiary health care centers play a prime role to avoid such mishap. OBJECTIVES: To study the incidence and indication of postpartum laparotomy, obstetric and medical risk factors, maternal and fetal outcome of surgery irrespective of the mode of delivery. METHODS: A retrospective study was conducted in Christian Medical College, Vellore, a tertiary health care hospital, over a period of eleven years in the department of obstetrics and gynecology from January 2010 to December 2020 of those who required postpartum exploratory laparotomy irrespective of the mode of delivery. After IRB approval, Patient clinical information was retrieved from stored data and noted in the data collection sheet. The demographic, Qualitative and Quantitative variables including age, parity, indication of LSCS, medical risk factors, obstetric risk factors, blood loss, duration of hospital stay, indication of laparotomy and outcome was noted. Statistical analysis of various variables was done by the principal investigators and co investigators. The study was concluded by proposing measures to reduce the incidence of laparotomy and thereby preventing maternal morbidity and mortality. RESULTS: Out of the total deliveries in our hospital and cases referred from peripheral hospital from January 2010 to December 2020, 187 patients underwent postpartum laparotomy. Out of 187 cases, 99 patients delivered in our institute and 88 patients delivered elsewhere and were referred here. The incidence of postpartum laparotomy in our institute during the eleven year period was 6.63 per 10,000 births. The incidence following vaginal delivery was 2.53per 10,000 births and the incidence following cesarean section was 15.66 per 10,000 births. The relative risk of having postpartum laparotomy in patient who delivered by cesarean section was 6.18 times higher than patients who delivered vaginally (95% CI 12.37-19.58). The most common indication for postpartum laparotomy was puerperal sepsis. Other causes include PPH, rupture uterus, post-operative complication, etc. Among the obstetric risk factors and indication for CS, previous cesarean delivery contributed to be an important risk factor leading to postpartum laparotomy. CONCLUSIONS: Main finding of this eleven year retrospective analysis is that the risk of postpartum laparotomy is much higher after cesarean section compared to vaginal birth. This information must be taken into account by clinicians when considering mode of birth and can be interpreted as yet another reason to reduce unnecessary cesarean sections, especially when maternal request is the only indication. We also observed that majority of the patients who required exploratory laparotomy in postpartum period suffered morbidity in the form of prolonged hospital stay or transfusion of blood or blood products and some required 2nd/3rd laparotomy. Though the patients suffered morbidity, mortality could be prevented by timely intervention in majority of the patients