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01/01/2023 - 31/12/2024 |
Re-exploration after Caesarean Section |
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01/02/2024 - 31/01/2025 |
General anaesthesia for Caesarean Section |
BACKGROUND
GENERAL ANAESTHESIA FOR CAESAREAN SECTION
General anaesthesia is occasionally used for Caesarean section. It is associated with a higher risk for maternal complications, including serious anaesthesia-related complications, surgical site infection, and venous thromboembolic events. Moreover, it is associated with more postoperative pain and higher rates of postpartum depression requiring hospitalization. Additionally, it is associated with neonatal respiratory depression and lower Apgar scores (1).
References
1. Ring L, Landau R, Delgado C. The current role of general anesthesia for cesarean delivery. Current Anesthesiology Reports 2021; 11:18–27. https://doi.org/10.1007/s40140-021-00437-6
RE-EXPLORATION AFTER CAESAREAN SECTION
The prevalence of Caesarean Section (CS) is increasing worldwide (1-3) with around 21% of births in Belgium today being carried out by CS (4-6). Despite being a life-saving intervention in medically-indicated situations, research shows that a large proportion of these CSs are not medically advised (7).
Although safety of the procedure is increasing, women undergoing CS are exposed to short and long-term risks (7, 8). Surgical risks such as bleeding, wound infection or injury to surrounding organs might require a re-exploration. Re-laparotomy after CS comes with its own anesthetic and procedural risks, besides the increased risk of infection, blood transfusion, intensive care admission and increased length of hospital stay. The incidence of re-laparotomy is estimated to be between 0,1 and 1,0%, based on data obtained by retrospective single-center studies of small scope (9-16). Some of these studies have tried to determine risk factors for re-laparotomy after CS. Previous CS, emergent CS, placenta praevia, pre-eclampsia and longer operating time seemed to be the most found risk factors (9-17), but due to small numbers results were not conclusive. Therefore, larger, prospective investigations are necessary, as a better understanding of this severe complication is crucial to improve patient care.
The UKOSS (United Kingdom Obstetric Surveillance System) took the initiative to start up a survey on the complication within the International Network of Obstetric Survey Systems (18). Current study takes part of this INOSS initiative, gathering information on re-laparotomy after CS in Belgium. The primary aim of this study is to get knowledge about the incidence of re-laparotomy after CS in Belgium. Secondary aims are to determine risk factors and outcomes associated with re-exploration after CS in order to give better obstetric care and find preventive measures to reduce morbidity and mortality.
References
1. Antoine C, Young BK. Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly. J Perinat Med. 2020 Sep 4;49(1):5-16.
2. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021 Jun;6(6).
3. European Perinatal Health report: Euro-Peristat; 2022.
4. Goemaes R FE, Laubach M, De Coen K, Roelens K, Bogaerts A. Perinatale gezondheid in Vlaanderen – Jaar 2021. Brussels: Studiecentrum voor Perinatale Epidemiologie; 2022.
5. Leroy Ch VLV. Santé périnatale en Wallonie – Année 2021. Brussels: Centre d’Épidémiologie Périnatale; 2022.
6. Van Leeuw V LC. Santé périnatale en Région bruxelloise – Année 2021. Brussels: Centre d’Épidémiologie Périnatale; 2022.
7. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018 Oct 13;392(10155):1349-57.
8. Stordeur S JP, Fairon N De Laet C. Geplande keizersnede: wat zijn de gevolgen voor de gezondheid van moeder en kind? Brussels: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). Health Technology Assessment (HTA); 2016.
9. Seffah JD. Re-laparotomy after Cesarean section. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2005 Mar;88(3):253-7.
10. Lurie S, Sadan O, Golan A. Re-laparotomy after cesarean section. European journal of obstetrics, gynecology, and reproductive biology. 2007 Oct;134(2):184-7.
11. Gedikbasi A, Akyol A, Asar E, Bingol B, Uncu R, Sargin A, et al. Re-laparotomy after cesarean section: operative complications in surgical delivery. Archives of gynecology and obstetrics. 2008 Nov;278(5):419-25.
12. Kessous R, Danor D, Weintraub YA, Wiznitzer A, Sergienko R, Ohel I, et al. Risk factors for relaparotomy after cesarean section. J Matern Fetal Neona. 2012 Nov;25(11):2167-70.
13. Levin I, Rapaport AS, Salzer L, Maslovitz S, Lessing JB, Almog B. Risk factors for relaparotomy after cesarean delivery. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2012 Nov;119(2):163-5.
14. Ashwal E, Yogev Y, Melamed N, Khadega R, Ben-Haroush A, Wiznitzer A, et al. Characterizing the need for re-laparotomy during puerperium after cesarean section. Archives of gynecology and obstetrics. 2014 Jul;290(1):35-9.
15. Raagab AE, Mesbah YH, Brakat RI, Zayed AA, Alsaammani MA. Re-laparotomy after cesarean section: risk, indications and management options. Med Arch. 2014;68(1):41-3.
16. Ragab A, Mousbah Y, Barakat R, Zayed A, Badawy A. Re-laparotomy after caesarean deliveries: risk factors and how to avoid? J Obstet Gynaecol. 2015 Jan;35(1):1-3.
17. Weissmann-Brenner A, Barzilay E, Meyer R, Levin G, Harmatz D, Alakeli A, et al. Relaparotomy post-cesarean delivery: characteristics and risk factors. Archives of gynecology and obstetrics. 2021 Dec;304(6):1427-32.
18. Marian Knight NPEU. Re-exploration after Caesarean Section. UK obstetric Surveillance System (UKOSS); 2021.