Publication:

Post-relaparotomy morbidity and mortality patterns following gynecological and obstetrical surgeries: a tertiary care hospital experience

Background Relaparotomy following obstetrical and gynecological surgery is an uncommon but serious event associated with substantial maternal morbidity and mortality. Early identification of postoperative complications and timely surgical intervention are essential to improve outcomes. This study aimed to evaluate the morbidity and mortality pattern among patients undergoing relaparotomy following gynecological and obstetrical surgeries.

Methods This hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, over six months (November 2018 to April 2019). A total of 48 patients who required relaparotomy after obstetrical or gynecological abdominal surgery were included by consecutive sampling. Demographic characteristics, primary surgery, indications and timing of relaparotomy, operative findings, postoperative complications, treatment requirements and final outcomes were recorded and analyzed.

Results Among 48 patients, 39 (81.3%) underwent relaparotomy following obstetrical surgery and 9 (18.8%) following gynecological surgery. Caesarean section was the commonest primary procedure (64.6%). Hemoperitoneum or ongoing intra-abdominal hemorrhage was the leading indication for relaparotomy (33.3%), followed by sepsis/peritonitis (16.7%) and hematoma (14.6%). Overall, 60.4% of relaparotomies were performed within 24 hours. Major post-relaparotomy morbidities included sepsis (25.0%), hemorrhagic shock (20.8%), wound infection (18.8%) and acute kidney injury (14.6%). Blood transfusion was required in 81.3% and ICU/HDU admission in 31.3% of patients. Six patients died, giving an overall mortality rate of 12.5%.

Conclusions Relaparotomy was associated with considerable morbidity and mortality, predominantly due to hemorrhage and sepsis. Vigilant postoperative monitoring, early recognition of complications, prompt re-exploration and adequate critical-care support are essential to improve patient outcomes.