Prevalence and risk factor of postoperative adhesions following repeated cesarean section: A prospective cohort study

Abstract

Cesarean delivery is a commonly practiced obstetrical surgical intervention. 1 Its rate has risen worldwide, 1 reaching 52% in 2018 in Egypt. 2 This leads to increased repeat cesarean deliveries and related morbidity. 3 Intraperitoneal adhesions result from abdominal or pelvic surgeries. They have serious consequences such as intestinal obstruction, chronic pelvic pain, ectopic pregnancy, infertility, visceral

Can we predict peritoneal adhesions formation after cesarean delivery?

“…Salim et al 23 also did not demonstrate an association between adhesion formation and the time interval between the CD, a period of time that may indicate the occurrence of vaginal births after CD. Our results are also not in agreement with Aboshama et al, 8 which demonstrated that a higher parity order was associated with adhesion formation. It should be noted that in these studies the sample size was small and may have lacked the statistical power to identify some predisposing factors.…”

“…Our study found that a maternal age of 35 years or older at the first CD was associated with an increased risk for adhesion formation. This association was also observed by Hesselman et al 21 and Aboshama et al 8 Conversely, Herzberger et al 22 and Salim et al 23 did not find any effect of age on PA formation. Aside from the lack of statistical power in these studies, the findings may also be related to the consideration of age as a continuous rather than a dichotomous variable.…”

“…Furthermore, these studies did not include multivariable analysis to account for potential confounding variables. The findings of Aboshama et al 8 regarding the association between parity order and adhesion formation may be confounded by patient age. In our study, we found a protective effect of births before and between the two CD.…”

“…Also, increased injury to adjacent organs, increased length of hospital stay and higher risk for morbidity and mortality were observed. 7,8 Cesarean delivery (CD) is the most common major surgical procedure that women in the USA undergo; 9 the reported rate is increasing globally and regionally. 10,11 PA have been reported in 24%-46% of women during their second CD 12,13 and in up to 90% of women who had undergone a major gynecologic surgery.…”

“…In repeated surgery, the presence of adhesions was found to be related to laparoscopic surgery failure and the need to convert to laparotomy. Also, increased injury to adjacent organs, increased length of hospital stay and higher risk for morbidity and mortality were observed 7,8 …”