Relaparotomy After Cesarean Delivery: A Comprehensive Narrative Review

Abstract

Background: Relaparotomy after cesarean delivery (CD) is rare but high‑impact. Incidence ranges from ~0.16% to ~1.04% and most re‑operations occur within 24 hours, typically for bleeding (Amikam et al., 2024; Mandal et al., 2021; Raagab et al., 2014). Objective: To synthesize contemporary evidence on epidemiology, timing, risk factors, indications, operative strategies, outcomes, and prevention. Sources: Retrospective case–control and cohort studies, prospective series, and supportive literature on postpartum hemorrhage (PPH), infection, and wound complications (Levin et al., 2012; Lurie, 2007; Kessous et al., 2012; Shinar et al., 2013; Pencolé et al., 2021). Conclusions: Bleeding is the leading indication. Independent risks span pregnancy (placenta previa/abruption, hypertensive disorders, multiples, fibroids, Müllerian anomalies, ART conception) and intrapartum/intraoperative factors (emergency or second‑stage CD, prolonged/complicated surgery, heavy bleeding). Timely escalation—uterotonics, compression sutures/balloon, stepwise devascularization, and when necessary hysterectomy—can reduce morbidity (Amikam et al., 2024; Raagab et al., 2014; Mandal et al., 2021; Peker et al., 2020).