Analysis of the causes of relaparotomy after cesarean section (multicenter study)

Capa

Citar

Texto integral

Acesso aberto Acesso aberto
Acesso é fechado Acesso está concedido
Acesso é fechado Acesso é pago ou somente para assinantes

Resumo

Objective: To determine the characteristics of surgical strategies and methods for intra- and postoperative hemostasis in patients undergoing relaparotomy following a cesarean section.

Materials and methods: A multicenter cross-sectional descriptive study was conducted to analyze the clinical and anamnestic data along with treatment outcomes of 97 cases of relaparotomy due to bleeding after cesarean section, which occurred in secondary- and tertiary-level maternity hospitals. Data were collected from six regions of the Russian Federation over three years, from January 1, 2022, to December 1, 2024: n = 20, n = 27, n = 14, n = 8, n = 18, and n = 10.

Results: During the analyzed three years (2022–2024), 44,792 cesarean sections were performed in institutions that reported relaparotomies. The need for surgical hemostasis during the initial operation emerged in 19/97 (19.6%) patients. Relaparotomy was performed in 97 patients, accounting for 0.22% of the total number of cesarean sections. Bleeding after cesarean section was most frequently noted at a gestational age of 37.0 (3) weeks. Relaparotomy was performed in 44 cases following planned operations, in 13 cases urgently, and in 40 cases emergently. Early postoperative bleeding (within 6 h), necessitating re-entry into the abdominal cavity, occurred in 69/97 (71.1%) parturient women. During relaparotomy, the uterus was removed as a source of bleeding in 21/97 (21.6%) cases. Ligation of the internal iliac arteries was performed in 19/97 (19.6%) patients, including five during hysterectomy and 14 while conserving the uterus. Three patients underwent repeated relaparotomy due to ongoing intra-abdominal bleeding. The mean total blood loss resulting from the two surgical interventions was 3,319 mL (1,960) ml. Blood transfusions were administered to 62 patients, of whom three received reinfusion in combination with donor erythrocytes. The mean blood transfusion volume was 1,261 (1,483) ml. The mean duration of stay in the intensive care unit was 65 (55) hours. Transfer to another institution was required in 25/97 (25.8%) postpartum women.

Conclusion: Bleeding most often occurred after planned surgery in pregnant women with uterine scars, indicating an insufficient assessment of risk factors and their prevention. Complex compression hemostasis is most frequently used to stop bleeding, which should be mastered by all surgeons performing cesarean sections.

Texto integral

Acesso é fechado

Sobre autores

Nikolay Zharkin

Volgograd State Medical University

Email: zharkin55@mail.ru
ORCID ID: 0000-0002-8094-0427

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology

Rússia, 1, Pavshikh Bortsov Sqr., Volgograd, 400066

Anatoly Miroshnikov

Volgograd State Medical University

Autor responsável pela correspondência
Email: miroshnikov-7@mail.ru
ORCID ID: 0000-0002-3731-0825

PhD, Associate Professor at the Department of Obstetrics and Gynecology

Rússia, 1, Pavshikh Bortsov Sqr., Volgograd, 400066

Tatyana Kostenko

Volgograd State Medical University

Email: kostenko.ti@mail.ru
ORCID ID: 0000-0001-5203-3400

PhD, Associate Professor at the Department of Obstetrics and Gynecology of the Institute for Continuing Medical and Pharmaceutical Education

Rússia, 1, Pavshikh Bortsov Sqr., Volgograd, 400066

Anastasia Shatilova

Volgograd State Medical University

Email: juliashatilova2012@yandex.ru

5th-Year Student

Rússia, 1, Pavshikh Bortsov Sqr., Volgograd, 400066

Sergey Dvoryansky

Kirov State Medical University

Email: dvorsa@mail.ru
ORCID ID: 0000-0002-5632-0447

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology

Rússia, 112, К. Мarx St., Kirov, 610998

Svetlana Dmitrieva

Kirov State Medical University

Email: swdmitr09@yandex.ru
ORCID ID: 0000-0002-2505-0202

PhD, Associate Professor at the Department of Obstetrics and Gynecology

Rússia, 112, К. Мarx St., Kirov, 610998

Vitaly Tskhay

Professor Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: tchai@yandex.ru
ORCID ID: 0000-0003-2228-3884

Dr. Med. Sci., Professor, Head of the Department of Perinatology, Obstetrics and Gynecology

Rússia, 1, Partizan Zheleznyak St., Krasnoyarsk, 660022

Yuri Raspopin

Professor Voyno-Yasenetsky Krasnoyarsk State Medical University; Krasnoyarsk Regional Clinical Center for Maternal and Child Health

Email: oar24@mail.ru
ORCID ID: 0000-0001-5550-1628

PhD, Associate Professor at the Department of Anesthesiology and Resuscitation of the Institute for Postgraduate Education; Head of the Department of Anesthesiology and Resuscitation

Rússia, 1, Partizan Zheleznyak St., Krasnoyarsk, 660022; 2a/1, Kirensky St., Krasnoyarsk, 660074

Maria Falkenberg

Professor Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: mariafalkenberg@yandex.ru

Student at the General Medicine Faculty

Rússia, 1, Partizan Zheleznyak St., Krasnoyarsk, 660022

Marina Marina

Professor Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: marina.veter2016@yandex.ru

Student at the General Medicine Faculty

Rússia, 1, Partizan Zheleznyak St., Krasnoyarsk, 660022

Natalya Artymuk

Kemerovo State Medical University

Email: artymuk@gmail.com
ORCID ID: 0000-0001-7014-6492

Dr. Med. Sci., Professor, Head of the Prof. Ushakov Department of Obstetrics and Gynecology

Rússia, 22a, Voroshilov St., Kemerovo, 650056

Tatyana Marochko

Kemerovo State Medical University

Email: marochko.2006.68@mail.ru
ORCID ID: 0000-0001-5641-5246

PhD, Associate Professor at the Prof. Ushakov Department of Obstetrics and Gynecology

Rússia, 22a, Voroshilov St., Kemerovo, 650056

Olga Guseva

Volga Region Research Medical University

Email: alise52@yandex.ru
ORCID ID: 0009-0002-1241-7076

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Faculty of Continuing Professional Education

Rússia, 10/1, Minin and Pozharsky Sqr., Nizhny Novgorod, 603005

Anna Soboleva

Volga Region Research Medical University

Email: anna.sofonova@yandex.ru

Resident at the Department of Obstetrics and Gynecology of the Faculty of Continuing Professional Education

Rússia, 10/1, Minin and Pozharsky Sqr., Nizhny Novgorod, 603005

Tatyana Panova

City Clinical Hospital No. 40

Email: tatvpanova@yandex.ru

PhD, Head of the Department of Maternal Pathology No. 5 of the Regional Perinatal Center

Rússia, Bldg. 5, 71, Hero Yuri Smirnov St., Nizhny Novgorod, 603083

Mikhail Padrul

Academician Wagner Perm State Medical University

Email: psmu@psma.ru
ORCID ID: 0000-0002-6111-5093

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 1

Rússia, 26, Petropavlovskaya St., Perm, 614000

Andrey Trushkov

Tverje City Clinical Hospital

Email: trushkovi@yandex.ru
ORCID ID: 0009-0002-6068-8436

PhD, Deputy Chief Physician for Obstetrics and Gynecology

Rússia, 2, Bratya Ignatovy St., Perm, 614036

Bibliografia

  1. Всемирная организация здравоохранения. Рекомендации ВОЗ по профилактике и лечению послеродового кровотечения. Женева: ВОЗ; 2014. 41 с. [World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2014. 41 p. (in Russian)].
  2. Andrikopoulou M., D'Alton M.E. Postpartum hemorrhage: early identification challenges. Semin. Perinatol. 2019; 43(1): 11-7. https://dx.doi.org/10.1053/ j.semperi.2018.11.003
  3. Артымук Н.В., Белокриницкая Т.Е. Кровотечения в акушерской практике. Руководство для врачей. М.: ГЭОТАР-Медиа; 2024. 232 с. [Artymuk N.V., Belokrinitskaya T.E. Bleeding in obstetric practice. A guide for doctors. Moscow: GEOTAR-Media; 2024. 232 p. (in Russian)].
  4. Белоцерковцева Л.Д., Иванников С.Е., Мирзозода М.Т. Аудит случаев релапаротомии после родов. Вестник СурГУ. Медицина. 2019; 2(40): 50-6. [Belotserkovtseva L.D., Ivannikov S.E., Mirzozoda M.T. Cases audit of relaparotomy after delivery. Bulletin of Surgut State University. Medicine. 2019; 2(40): 50-6 (in Russian)].
  5. Akkurt M.O., Coşkun B., Guclu T., Cift T., Korkmazer E. Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding. J. Maternal-Fetal and Neonatal Medicine. 2018; 33(10): 1-5. https://dx.doi.org/10.1080/14767058.2018.1527309
  6. Курбонов Ш.М., Курбонов К.М., Ахмедова З.Б. Акушерские кровотечения после кесарева сечения и методы их лечения: состояние проблемы и перспективы. Вестник последипломного образования в сфере здравоохранения. 2020; 4: 83-91. [Kurbonov Sh.M., Kurbonov K.M., Akhmedova Z.B. Obstetric bleeding after cesarean section and their treatment methods: the problem state and prospects. Bulletin of postgraduate education in health care. 2020; 4: 83-91 (in Russian)].
  7. Liu L.Y., Nathan L., Sheen J.J., Goffman D. Review of current insights and therapeutic approaches for the treatment of refractory postpartum hemorrhage. Int. J. Womens Health. 2023; 15: 905-26. https://dx.doi.org/10.2147/ IJWH.S366675
  8. Huras H., Radon-Pokracka M., Nowak M. Relaparotomy following cesarean section − a single center study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 225: 185-88. https://dx.doi.org/10.1016/j.ejogrb.2018.04.034
  9. Курбонов Ш.М. Анализ клинико-анамнестических данных пациенток, перенесших релапаротомию и повторные миниинвазивные вмешательства после акушерско-гинекологических операций. Медицинский вестник Национальной академии наук Таджикистана. 2021; 11(1): 21-8. [Kurbonov Sh.M. Clinical and anamnestic data analysis of patients who underwent relaparotomy and repeated minimally invasive interventions after obstetric and gynecological surgeries. Medical Bulletin of the National Academy of Sciences of Tajikistan. 2021; 11(1): 21-8 (in Russian)].
  10. Артымук Н.В., Марочко Т.Ю., Артымук Д.А., Апресян С.В., Колесникова Н.Б., Аталян А.В., Шибельгут Н.М., Батина Н.А. Факторы риска и протективные факторы рефрактерного послеродового кровотечения. Акушерство и гинекология. 2024; 10: 82-90. [Artymuk N.V., Marochko T.Yu., Artymuk D.A., Apresyan S.V., Kolesnikova N.B., Atalyan A.V., Shibelgut N.M., Batina N.A. Risk factors and protective factors of refractory postpartum hemorrhage. Obstetrics and Gynecology. 2024; (10): 82-90 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.169
  11. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Роды одноплодные, родоразрешение путем кесарева сечения. М.; 2021. 44 c. [Ministry of Health of the Russian Federation. Clinical guidelines. Singleton birth. Delivery by cesarean section. Moscow; 2021. 44 p. (in Russian)].
  12. Баринов С.В. Медянникова И.В., Тирская Ю.И., Безнощенко Г.Б., Кадцына Т.В., Лазарева О.В., Чуловский Ю.И., Проданчук Е.Г., Цыганкова О.Ю., Галянская Е.Г. Тромбоэластография в акушерской практике. Вопросы гинекологии, акушерства и перинатологии. 2022; 21(2): 63-8. [Barinov S.V., Medyannikova I.V., Tirskaya Yu.I., Beznoshchenko G.B., Kadtsyna T.V., Lazareva O.V., Chulovsky Yu.I., Prodanchuk E.G., Tsygankova O.Yu., Galyanskaya E.G. Thromboelastography in obstetric practice. Gynecology, Obstetrics and Perinatology. 2022; 21(2): 63-8 (in Russian)]. https://dx.doi.org/10.20953/1726-1678-2022-2-63-68
  13. Жаркин Н.А., Бурова Н.А., Мирошников А.Е., Шатилова Ю.А. Интраоперационный гемостаз при преждевременном отделении нормально расположенной плаценты – право выбора. Доктор.Ру. 2024; 23(5): 37-42. [Zharkin N.A., Burova N.A., Miroshnikov A.E., Shatilova Yu.A. Intraoperative hemostasis with placenta abruption — the right choice. Doctor.Ru. 2024; 23(5): 37-42 (in Russian)]. https://dx.doi.org/10.31550/ 1727-2378-2024-23-5-37-42

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar

Declaração de direitos autorais © Bionika Media, 2025