Is Presence of Fluid in Uterus or Peritoneal Cavity Forty Eight Hours After Caesarian Section Correlated with Post-Operative Morbidity?

Anam Mahreen; Sadia Zaineb; Syeda Uzma

doi:10.51253/pafmj.v76i3.10047

Authors

Anam Mahreen Department of Gynecology and Obstetrics, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Sadia Zaineb Department of Gynecology and Obstetrics, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Syeda Uzma Department of Gynecology and Obstetrics, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i3.10047

Keywords:

Caesarean Section, Hematoma, USG Abdomen

Abstract

Objective: To study the association of fluid in uterus or peritoneal cavity forty-eight hours after caesarian section with post-operative morbidity.

Study Design: Prospective Analytical Study

Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital Bahawalpur, Pakistan from Jan to Nov 2022.

Methodology: Female patients of 20-40 years of age who developed fever, vaginal discharge or abdominal pain after LSCS, singleton pregnancy, more than 37 weeks of gestation with no use of prostaglandins and elective LSCS were included. The USG abdomen and pelvis was performed 48 hours after LSCS by a consultant Radiologist to see any pelvic collection. The collected data was analyzed on (SPSS) version 24.0.

Results: 60 patients were included in the study. Mean age of patients was 32.55 ± 5.96 years. 28 patients had pelvic fluid collection on USG after 48hours of surgery on USG abdomen and pelvis. Most common collection found was Bladder flap hematoma which was found in 13 (46.42%) patients. 33 patients developed fever, out of them 21(63.6%) had fluid collection which was statistically significant (p value 0.002).

Conclusion: USG abdomen and pelvis is an easily available and recommended investigation in patients presenting with complications in early postoperative period after LSCS thereby decreasing maternal morbidity. In patients presenting with fever in early postoperative time always rule out a pelvic/bladder wall or subfascial hematoma which may be the causative agent.

Downloads

Download data is not yet available.

References

1. Somani SS, Sudhir S, Somani SG, Bushra. A study of intra-operative maternal morbidity after repeating caesarean section. Int J Reprod Contracept Obstet Gynecol 2018; 7(1): 291-297.

https://doi.org/10.18203/2320-1770.ijrcog20175864

2. Suhail JM, Ashraf O, Kiran S. Imaging Interpretation of Complications after Cesarean Section Delivery. Int J Cur Res Rev 2021; 13(15): 143.

https://doi.org/10.31782/IJCRR.2021.131532

3. Priyanka P, Abraham K, Navneetham P, Abraham A, Regi A. Vaginal birth as compared with cesarean section in preterm twins-Experience from a tertiary center of a middle-income country. Int J Gynaecol Obstet 2023; 161(2): 560-567.

https://doi.org/10.1002/ijgo.14589

4. Poliquin V, Singh PK, Leylek M, Dean E, Liu M, Altman AD. The Risk of Postoperative Infectious Complications Following Massive Intraoperative Blood Loss During Gynaecologic Laparotomy: Retrospective Cohort Study. J Obstet Gynaecol Can 2021; 43(1): 19-25.

https://doi.org/10.1016/j.jogc.2020.07.013

5. Padumadasa S, Goonewardene M. Primary Postpartum Haemorrhage. Obstetric Emergencies: A Practical Manual 2021; 23: 172-193.

6. Fawcus S. Practical approaches to managing postpartum haemorrhage with limited resources. Best Pract Res Clin Obstet Gynaecol 2019; 61: 143-155.

https://doi.org/10.1016/j.bpobgyn.2019.03.009

7. Laganà AS, Garzon S, Franchi M, Ghezzi F. Ultrasonographic evaluation of normal and pathologic puerperium. In: Malvasi A, editor. Intrapartum ultrasonography for labor management. Cham: Springer; 2021 p: 615-631.

https://doi.org/10.1007/978-3-030-57595-3_49

8. Krishnaswamy PH, Jha S, Krishnan M. Efficiency of using a vaginal drain after hysterectomy: A systematic review. Eur J Obstet Gynecol 2019; 237: 175-180.

https://doi.org/10.1016/j.ejogrb.2019.04.020

9. Thomson AJ, Sproston AR, Farquharson RG. Ultrasound detection of vault haematoma following vaginal hysterectomy. Br J Obstet Gynaecol 1998; 105(2): 211-215.

https://doi.org/10.1111/j.1471-0528.1998.tb10055.x

10. Koskas M, Nizard J, Salomon LJ, Ville Y. Abdominal and pelvic ultrasound findings within 24 hours following uneventful Cesarean section. Ultrasound Obstet Gynecol 2008; 32(4): 520-526. https://doi.org/10.1002/uog.6120

11. Rani SU, Vidyayini R, Padmanaban S. Perinatal outcome in pregnancies with preterm premature rupture of membranes inclusive of extreme pre term. Int J Gynecol Obstet 2019; 3(2): 1-4.

https://doi.org/10.33545/gynae.2019.v3.i2a.01

12. Bijjaragi B, Amulya MN. Re-laparotomy in OBG: a clinical study. Int J Reprod Contracept Obstet Gynecol 2018; 7(4): 1367-1372.

https://doi.org/10.18203/2320-1770.ijrcog20181021

13. Nair AD, Manchanda S, Gamanagatti S, Kachhawa G, Bhatla N. Post caesarean section complications conundrum: Role of imaging. Br J Radiol 2022; 95(1138): 20211344.

https://doi.org/10.1259/bjr.20211344

14. Antonelli E, Morales MA, Dumps P, Boulvain M, Weil A. Sonographic detection of fluid collections and postoperative morbidity following Cesarean section and hysterectomy. Ultrasound Obstet Gynecol 2004; 23(4): 388-392.

https://doi.org/10.1002/uog.1023

15. Faustin DA, Minkoff HO, Schaffer RI, Crombleholme WI, Schwarz RI. Relationship of ultrasound findings after cesarean section to operative morbidity. Obstet Gynecol 1985; 66(2): 195-198.

16. Gemer O, Shenhav S, Segal S, Harari D, Segal O, Zohav E. Sonographically diagnosed pelvic hematomas and postcesarean febrile morbidity. Int J Gynaecol Obstet 1999; 65(1): 7-9.

https://doi.org/10.1016/s0020-7292(99)00003-x

17. Toglia MR, Pearlman MD. Pelvic fluid collections following hysterectomy and their relation to febrile morbidity. Obstet Gynecol 1994; 83(5 Pt 1): 766-770.

18. Kahveci B, Obut M, Ege S, Sucu M, Peker N, Uzundere O, et al. Evaluation and management of patients with hematoma after gynecologic and obstetric surgery. Obstet Gynaecol Reprod Med 2021; 27(1): 60-64. https://doi.org/10.21613/GORM.2019.961

19. Al-Inany H, Youssef G, Abd ElMaguid A, Hamid MA, Naguib A. Value of subcutaneous drainage system in obese females undergoing cesarean section using Pfannenstiel incision. Gynecol Obstet Invest 2002; 53(2): 75-78.

https://doi.org/10.1159/000052996

20. Chill HH, Porat LB, Winer J, Moss NP, Cohen A, Shveiky D. Infected pelvic hematoma following vaginal hysterectomy with uterosacral ligament suspension for treatment of apical prolapse. Eur J Obstet Gynecol 2022; 271: 97-101.

https://doi.org/10.1016/j.ejogrb.2022.02.006