Postcesarean delivery adhesions associated with delayed delivery of infant

Morales, Kelly J.; Gordon, Michael; Bates, G. Wright

doi:10.1016/j.ajog.2006.12.017

Cited by 100 publications

(85 citation statements)

References 11 publications

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“…In one study, the rate of adhesion was determined as 7% in primary CD, whereas 65% in those with three CDs [18]. In other studies, the prevalence of adhesions was 12-46% in women with two CDs, and 26-75% in those with three CDs [9,[19][20][21][22]. In our study, the rate of dense adhesion was 18.7% in the control group and 27.5% in the study group.…”

Section: Discussionmentioning

confidence: 50%

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The effect of increased number of cesarean on maternal and fetal outcomes

Çintesun

2017

Ginekol Pol

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Objectives: The aim of this study was to evaluate the effects of multiple cesarean deliveries (CDs) on maternal-fetal morbidity and mortality rates. Material and methods:This retrospective study included a total of 1,506 patients who underwent multiple CDs between January 2006 and May 2014. The patients were divided into two groups. One group consisted of patients with four or more CDs (n = 444) and a control group of patients with three CDs (n=1,062). Both groups were analyzed for demographics, complications from multiple cesarean deliveries and perinatal outcomes. Results:The mean age was higher in the study group (p < 0.001). Dense adhesion (p < 0.001), demand for tubal ligation (p < 0.001), the requirement of pelvic drainage (p < 0.001), duration of hospitalization (p < 0.001) and the requirement for blood transfusion (p=0.03) was also significantly higher in the study group. Hemoglobin levels (p = 0.002) were significantly higher in the control group on the second postoperative day. Regarding perinatal morbidity; umbilical artery pH results (p = 0.003) were significantly lower in the study group. There was no significant difference in the maternal and fetal mortality rates between both groups.Conclusions: According to our study results, an increase in the number of cesarean sections increases maternal and fetal morbidity rates significantly. Therefore, we recommend decreasing the rate of primary cesarean deliveries by encouraging vaginal birth after CD. We also advocate the use of permanent contraceptive methods in patients with a high number of CD's. Further large-scale prospective results are required to establish a definitive conclusion.

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Section: Discussionmentioning

confidence: 50%

“…Adhesion is a condition that can occur after every abdominal operation. Adhesion may prolong the duration of the operation and may cause bladder or bowel injury, increased bleeding and delayed delivery of the fetus [14][15][16]. In many studies, the relationship between the frequency of CD and adhesion has been observed [6,10,13,17].…”

Section: Discussionmentioning

confidence: 99%

The effect of increased number of cesarean on maternal and fetal outcomes

Çintesun

2017

Ginekol Pol

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“…The reported prevalence of adhesions in women during their second CS is 12 -46% and 26 -75% during their third CS (Makoha et al, 2004;Morales et al, 2007;Tulandi et al, 2009;Walfisch et al, 2014).…”

Section: Hypothesis 2: Incomplete Closure Of the Uterine Wallmentioning

confidence: 99%

Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development

Vervoort

Uittenbogaard

Hehenkamp

et al. 2016

Obstetrical &Amp; Gynecological Survey

108

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Caesarean section (CS) results in the occurrence of the phenomenon 'niche'. A 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6-12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.

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“…8 After gynecologic surgery, intraperitoneal adhesions form in 55% to 100% of patients [9][10][11] ; however, rates of adhesion development recorded at a second cesarean delivery (CD) are lower and ranged from 24% to 46%, although they increase from 43% to 75% at the third, and up to 83% at the fourth CD. [12][13][14] The lower rates of adhesion reported at the second CD compared to laparotomy for nonobstetric indications would suggest that patients having CD may develop fewer adhesions. In addition, evidence in the literature suggests that the consequences of postoperative adhesions as it relates to bowel obstruction, 15 infertility, 16,17 ectopic pregnancy, 18 and chronic pain 19 may be less following CD compared with gynecological surgery.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

et al. 2011

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In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.

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Postcesarean delivery adhesions associated with delayed delivery of infant

Cited by 100 publications

References 11 publications

The effect of increased number of cesarean on maternal and fetal outcomes

The effect of increased number of cesarean on maternal and fetal outcomes

Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

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