Closure versus non-closure of the visceral peritoneum (VP) in patients with gestational hypertension--an observational analysis.

Abstract:

INTRODUCTION:Caesarean section (CS) is one of the most frequently performed surgical procedures worldwide. Surgical variants include closure and non-closure of the peritoneum: in case of non-suturing the visceral peritoneum (VP), abnormal fluid collections such as blood clots may lead to formation of a hematoperitoneum. MATERIAL AND METHODS:In this retrospective, observational study we reviewed 1848 patients with gestational hypertension (GH) undergoing repeat and primary CS performed by non-closure of the visceral peritoneum (VP). RESULTS:Six of these patients had major early post-CS complications: 5 patients experienced hypovolaemic shock that required urgent operative intervention. Four patients underwent repeat laparotomy and one patient was treated by laparoscopy. CONCLUSION:As an early major post-CS complication, hematoperitoneum occurs in cases with poor haemostasis and/or with haemodynamic disorders such as GH. A decrease in blood pressure (BP) during CS caused by spinal/epidural anaesthesia and the following BP increase in GH patients may favour bleeding complications. Closure of the VP may facilitate early detection of a subperitoneal hematoma. In contrast, hematoperitoneum may develop in cases of non-closure of the VP followed by hypovolemic shock. Early and aggressive intervention results in excellent prognosis of this complication.

journal_name

Hypertens Pregnancy

authors

Malvasi A,Tinelli A,Hudelist G,Vergara D,Martignago R,Tinelli R

doi

10.1080/10641950802601229

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

290-9

issue

3

eissn

1064-1955

issn

1525-6065

pii

910920418

journal_volume

28

pub_type

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