Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies

Pergialiotis, Vasilios; Frountzas, Maximos; Siotos, Charalampos; Karampetsou, Nikoleta; Perrea, Despina; Vlachos, Dimitrios‐Efthymios

doi:10.1080/14767058.2016.1176135

Cited by 19 publications

(24 citation statements)

References 21 publications

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“…Many of the abdominal scar features were considered to have an association with adhesions by many authors, such as Çim et al, who found that depressed scars with hypopigmentation are associated with adhesions [19]. Pergialiotis et al [20] undertook a meta-analysis of several observational studies and concluded that depressed scars were positively associated with intra-abdominal adhesions, while flat scars were predictive of the absence of adhesions. In spite of that, the authors noted that the number of published studies is small, and thus recommended further research to confirm their findings [20].…”

Section: Discussionmentioning

confidence: 99%

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery

2019

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Objectives: The aim of the present study has been to examine skin scar characteristics and striae gravidarum, considering the reliability of each for predicting adhesions in repeat Caesarean sections. Material and methods: A cross-sectional study was done over a period of two years. One hundred pregnant women were invited to participate in the study. Preoperatively, abdominal scar features (according to the scar's appearance) and stria gravidarum were both recorded. Then, at the time of surgery, intraabdominal adhesions were graded according to the modified Nair's classification. Results: Among the skin markers, abdominal scar width (p = 0.001), depressed scar (p = 0.002) and striae colour grading (p = 0.0183) were found to have significant associations with intraabdominal adhesions; yet all were of low validity. Conclusions: Despite growing interest in the use of skin markers in the prediction of intraabdominal adhesions at the time of repeat CS, the present study demonstrates that these markers may not be reliable.

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Section: Discussionmentioning

confidence: 99%

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery

2019

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“…The uterus often was retroflexed, forming an angle with the distended urinary bladder. Presence of adhesions may also be predicted by Cesarean wound scar characteristics or by intraoperative peritoneal adhesion index. Dynamic ultrasound assessment of sliding sign has been used before to predict adhesions before laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The literature addressing the risk of intra‐abdominal adhesions following Cesarean section is limited and none of the studies focuses on the third trimester of pregnancy, which is the most relevant time for counseling and planning the surgery of patients with previous abdominal surgery delivering by CS. It is important for surgeons to identify patients with high risk of adhesions in order to allow a preoperative multidisciplinary surgical discussion, and also to inform the patient about the potential high risk of complications associated with repeat abdominal surgery.…”

Section: Introductionmentioning

confidence: 99%

Sliding sign in third‐trimester sonographic evaluation of intra‐abdominal adhesions in women undergoing repeat Cesarean section: a novel technique

Baron

Tirosh

Mastrolia

et al. 2018

Ultrasound in Obstet & Gyne

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“…Depressed hypopigmented scars were also associated with adhesions, which were assumed to arise from the inward traction from the adhesion bands (17,18). Besides, in a meta-analysis of numerous studies, they reported that at scars were indicative of absent adhesions while depressed ones were associated with adhesions (19). Con icting results exist as elevated scars were found to be associated with more adhesions all over the abdomen than at or depressed ones (20).…”

Section: Discussionmentioning

confidence: 99%

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

Elprince

Taha

Khamees

et al. 2020

Preprint

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Background: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions.Methods: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions.Results: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value <0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of <0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value <0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001).Conclusion: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

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Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies

Abstract: According to our meta-analysis, abdominal wound characteristics following cesarean section can predict the presence of adhesions. However, given the small number of published studies, further research is needed to corroborate our findings.

Cited by 19 publications

References 21 publications

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery

Sliding sign in third‐trimester sonographic evaluation of intra‐abdominal adhesions in women undergoing repeat Cesarean section: a novel technique

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

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