Re-exploration after Caesarean Section

Key points

• Re-exploration following Caesarean Section (CS) is a rare event and has been poorly researched with no prospective studies having been undertaken in the UK.
• Re-exploration after CS exposes women to further anaesthetic and surgical risk.
• Research is needed to understand the risk factors for the condition, the main indications for and findings of the re-exploration following CS in order to describe factors which are more likely to be associated with a positive laparotomy.

Surveillance period

1^st June 2021 – 31^st May 2022

Background

Caesarean section (CS) is one of the most common procedures carried out in obstetrics and although the safety of CS is increasing, complications such as bleeding, wound infection and visceral injury occur and at times these complications might warrant a return to theatre for wound re-exploration or laparotomy. Re-exploration after CS can increase risk of infection, risk of blood transfusion, intensive care admission and increased length of hospital stay for women (1), as well as a repeat anaesthetic risk, which can affect the physical, emotional and mental wellbeing of the mother. It can also have a negative impact on the woman's ability to bond with or breastfeed her baby. The incidence of re-exploration after CS has been estimated to be around 0.12 - 0.13% (2) with very wide estimates of associated maternal mortality (3-12). A significant proportion of re-explorations find no evidence of pathology. No prospective studies have so far been undertaken in the UK, therefore this study will establish incidence and identify the main risk factors and outcomes associated with re-exploration after CS for women in the UK. The results will also assist clinicians with how to counsel women and inform future research.

Objective

To use the UK Obstetric Surveillance System (UKOSS) to describe the incidence, risk factors, current management and outcomes of re-exploration following CS.

Research questions

• What is the incidence of re-exploration following CS in the UK?
• What are the factors associated with re-exploration after CS?
• What are the main indications for, and findings of, the re-exploration following CS?
• What is the post-operative morbidity and mortality of re-exploration following CS to enable individualised information to be provided to women?

Case definition

Any woman who has a Caesarean Section (CS) AND who returns to theatre AND has either an exploration of the CS wound with the rectus sheath (RS) re-opened, or a formal laparotomy (opening ofthe peritoneum) within 28 days of CS.

Funding

This study is funded by The National Institute of Academic Anaesthesia (NIAA) and Manchester University Hospitals NHS Foundation Trust.

Ethics committee approval

This study has been approved by the North London Brent REC (Ref. Number: 10/H0717/20).

Investigators

Kailash Bhatia, Sarah Vause, Malachy Columb, Manchester University Hospitals NHS Foundation Trust

Marian Knight, National Perinatal Epidemiology Unit

Sample Data Collection Form

Re-laparotomy after Caesarean Section Form June 2021