Subfascial hematomas and hemoperitoneum after cesarean section: prevalence according to closure and non-closure of the parietal peritoneum

Abstract

Aim: To compare early hemorrhagic complications and the surgical and clinical outcome in the closure and non-closure of the parietal peritoneum in cesarean section (CS) patients.

Material and methods: We retrospectively evaluated 2,576 post-CS women subdivided and compared in two groups by open and closed parietal peritoneum (group I, n = 1,580, group II, n = 996).

Results: The ultrasonographical detection of 23 blood collections (0.89%) was 14 in group I and 9 in group II, and of these we surgically treated 11 patients in group I and 8 patients in group II, with no statistical difference (p > 0.05); all group I patients showed hemoglobin point decreases and needed blood transfusions, with statistical significance (p < 0.05) linked to more severe early complications that make the post-CS outcome worse; no difference was confirmed in terms of antibiotic administration (p > 0.05).

Conclusions: There was a significant increase of blood loss and transfusions in the first group. As the posterior surface of the Retzius space is open and if post-CS pathological bleeding occurs, blood can invade the peritoneal cavity causing a hemoperitoneum, with the possibility of hemorrhagic shock and a worse clinical outcome.