Skip to main content
SpringerLink
Log in

Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose of investigation

We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity.

Materials and methods

We analyzed intra-abdominal adhesions of 672 patients.

Results

Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively.

Conclusions

Emergency operations and adhesions increased complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morales KJ, Gordon MC, Bates GW Jr (2007) Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 196(5):461. doi:10.1016/j.ajog.2006.12.017 (e461–466)

    Article  PubMed  Google Scholar 

  2. Kupari M, Talola N, Luukkaala T, Tihtonen K (2016) Does an increased cesarean section rate improve neonatal outcome in term pregnancies? Arch Gynecol Obstet 294(1):41–46. doi:10.1007/s00404-015-3942-4

    Article  PubMed  Google Scholar 

  3. Herzberger EH, Alon H, Hershko-Klement A, Ganor-Paz Y, Fejgin MD, Biron-Shental T (2015) Adhesions at repeat cesarean delivery: is there a personal impact? Arch Gynecol Obstet 292(4):813–818. doi:10.1007/s00404-015-3718-x

    Article  PubMed  Google Scholar 

  4. Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V (2009) Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 201(1):56. doi:10.1016/j.ajog.2009.04.039 (e51–56)

    Article  PubMed  Google Scholar 

  5. Clark SL, Koonings PP, Phelan JP (1985) Placenta previa/accreta and prior cesarean section. Obstet Gynecol 66(1):89–92

    CAS  PubMed  Google Scholar 

  6. Grobman WA, Gersnoviez R, Landon MB, Spong CY, Leveno KJ, Rouse DJ, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, O’Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, National Institute of Child H, Human Development Maternal-Fetal Medicine Units N (2007) Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol 110(6):1249–1255. doi:10.1097/01.AOG.0000292082.80566.cd

    Article  PubMed  Google Scholar 

  7. Odibo AO, Cahill AG, Stamilio DM, Stevens EJ, Peipert JF, Macones GA (2007) Predicting placental abruption and previa in women with a previous cesarean delivery. Am J Perinatol 24(5):299–305. doi:10.1055/s-2007-981430

    Article  PubMed  Google Scholar 

  8. Rouse DJ, MacPherson C, Landon M, Varner MW, Leveno KJ, Moawad AH, Spong CY, Caritis SN, Meis PJ, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, National Institute of Child H, Human Development Maternal-Fetal Medicine Units N (2006) Blood transfusion and cesarean delivery. Obstet Gynecol 108(4):891–897. doi:10.1097/01.AOG.0000236547.35234.8c

    Article  PubMed  Google Scholar 

  9. de la Cruz CZ, Thompson EL, O’Rourke K, Nembhard WN (2015) Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Arch Gynecol Obstet 292(6):1201–1215. doi:10.1007/s00404-015-3790-2

    Article  PubMed  Google Scholar 

  10. Laughon SK, Wolfe HM, Visco AG (2005) Prior cesarean and the risk for placenta previa on second-trimester ultrasonography. Obstet Gynecol 105(5 Pt 1):962–965. doi:10.1097/01.AOG.0000158114.47925.fa

    Article  PubMed  Google Scholar 

  11. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP (2001) Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 345(1):3–8. doi:10.1056/NEJM200107053450101

    Article  CAS  PubMed  Google Scholar 

  12. Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192(5):1458–1461. doi:10.1016/j.ajog.2004.12.074

    Article  PubMed  Google Scholar 

  13. Zia S, Rafique M (2014) Intra-operative complications increase with successive number of cesarean sections: myth or fact? Obstet Gynecol Sci 57(3):187–192. doi:10.5468/ogs.2014.57.3.187

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bothin C, Okada M, Midtvedt T, Perbeck L (2001) The intestinal flora influences adhesion formation around surgical anastomoses. Br J Surg 88(1):143–145. doi:10.1046/j.1365-2168.2001.01613.x

    Article  CAS  PubMed  Google Scholar 

  15. Komoto Y, Shimoya K, Shimizu T, Kimura T, Hayashi S, Temma-Asano K, Kanagawa T, Fukuda H, Murata Y (2006) Prospective study of non-closure or closure of the peritoneum at cesarean delivery in 124 women: impact of prior peritoneal closure at primary cesarean on the interval time between first cesarean section and the next pregnancy and significant adhesion at second cesarean. J Obstet Gynaecol Res 32(4):396–402. doi:10.1111/j.1447-0756.2006.00420.x

    Article  PubMed  Google Scholar 

  16. O’Dwyer V, Hogan JL, Farah N, Kennelly MM, Fitzpatrick C, Turner MJ (2012) Maternal mortality and the rising cesarean rate. Int J Gynaecol Obstet 116(2):162–164. doi:10.1016/j.ijgo.2011.09.024

    Article  PubMed  Google Scholar 

  17. Biron-Shental T (2015) Reply to: “cesarean section and tissue adhesions”. Arch Gynecol Obstet 292(5):941. doi:10.1007/s00404-015-3806-y

    Article  PubMed  Google Scholar 

  18. Uygur D, Gun O, Kelekci S, Ozturk A, Ugur M, Mungan T (2005) Multiple repeat caesarean section: is it safe? Eur J Obstet Gynecol Reprod Biol 119(2):171–175. doi:10.1016/j.ejogrb.2004.07.022

    Article  PubMed  Google Scholar 

  19. Alpay Z, Saed GM, Diamond MP (2008) Postoperative adhesions: from formation to prevention. Semin Reprod Med 26(4):313–321. doi:10.1055/s-0028-1082389

    Article  CAS  PubMed  Google Scholar 

  20. Lyell DJ, Caughey AB, Hu E, Daniels K (2005) Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol 106(2):275–280. doi:10.1097/01.AOG.0000171120.81732.4c

    Article  PubMed  Google Scholar 

  21. Blumenfeld YJ, Caughey AB, El-Sayed YY, Daniels K, Lyell DJ (2010) Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions. BJOG 117(6):690–694. doi:10.1111/j.1471-0528.2010.02529.x

    Article  CAS  PubMed  Google Scholar 

  22. Ghazi A, Karim F, Hussain AM, Ali T, Jabbar S (2012) Maternal morbidity in emergency versus elective caesarean section at a tertiary care hospital. J Ayub Med Coll Abbottabad 24(1):10–13

    PubMed  Google Scholar 

  23. Moroz L, DiNapoli M, D’Alton M, Gyamfi-Bannerman C (2015) Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery. Am J Obstet Gynecol 213(4):584. doi:10.1016/j.ajog.2015.06.055 (e581–586)

    Article  PubMed  Google Scholar 

  24. Kok N, Ruiter L, Hof M, Ravelli A, Mol BW, Pajkrt E, Kazemier B (2014) Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study. BJOG 121(2):216–223. doi:10.1111/1471-0528.12483

    Article  CAS  PubMed  Google Scholar 

  25. Benzouina S, Boubkraoui Mel M, Mrabet M, Chahid N, Kharbach A, El-Hassani A, Barkat A (2016) Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat. Morocco. Pan Afr Med J 23:197. doi:10.11604/pamj.2016.23.197.7401

    PubMed  Google Scholar 

  26. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM, National Institute of Child H, Human Development Maternal-Fetal Medicine Units N (2006) Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107(6):1226–1232. doi:10.1097/01.AOG.0000219750.79480.84

    Article  PubMed  Google Scholar 

  27. Clark EA, Silver RM (2011) Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 205(6 Suppl):S2–10. doi:10.1016/j.ajog.2011.09.028

    Article  PubMed  Google Scholar 

  28. Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA (2001) Risk factors for surgical-site infections following cesarean section. Infect Control Hosp Epidemiol 22(10):613–617. doi:10.1086/501831

    Article  CAS  PubMed  Google Scholar 

  29. Doherty DA, Magann EF, Chauhan SP, O’Boyle AL, Busch JM, Morrison JC (2008) Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes. Aust N Z J Obstet Gynaecol 48(3):286–291. doi:10.1111/j.1479-828X.2008.00862.x

    Article  PubMed  Google Scholar 

  30. Bakhshi T, Landon MB, Lai Y, Spong CY, Rouse DJ, Leveno KJ, Varner MW, Caritis SN, Meis PJ, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai BM, Langer O, Thorp JM, Mercer BM (2010) Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision. Am J Perinatol 27(10):791–796. doi:10.1055/s-0030-1254238

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kamath BD, Todd JK, Glazner JE, Lezotte D, Lynch AM (2009) Neonatal outcomes after elective cesarean delivery. Obstet Gynecol 113(6):1231–1238. doi:10.1097/AOG.0b013e3181a66d57

    Article  PubMed  PubMed Central  Google Scholar 

  32. Berlit S, Welzel G, Tuschy B, Nickol J, Hornemann A, Sutterlin M, Kehl S (2013) Emergency caesarean section: risk factors for adverse neonatal outcome. Arch Gynecol Obstet 287(5):901–905. doi:10.1007/s00404-012-2679-6

    Article  PubMed  Google Scholar 

  33. Gedikbasi A, Akyol A, Bingol B, Cakmak D, Sargin A, Uncu R, Ceylan Y (2010) Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases. Taiwan J Obstet Gynecol 49(4):425–431. doi:10.1016/S1028-4559(10)60093-9

    Article  PubMed  Google Scholar 

  34. Suwal A, Shrivastava VR, Giri A (2013) Maternal and fetal outcome in elective versus emergency cesarean section. JNMA J Nepal Med Assoc 52(192):563–566

    PubMed  Google Scholar 

  35. Melamed N, Hadar E, Keidar L, Peled Y, Wiznitzer A, Yogev Y (2014) Timing of planned repeat cesarean delivery after two or more previous cesarean sections–risk for unplanned cesarean delivery and pregnancy outcome. J Matern Fetal Neonatal Med 27(5):431–438. doi:10.3109/14767058.2013.818130

    Article  PubMed  Google Scholar 

  36. Getahun D, Oyelese Y, Salihu HM, Ananth CV (2006) Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 107(4):771–778. doi:10.1097/01.AOG.0000206182.63788.80

    Article  PubMed  Google Scholar 

  37. Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB (2011) The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med 24(11):1341–1346. doi:10.3109/14767058.2011.553695

    Article  PubMed  Google Scholar 

  38. Downes KL, Hinkle SN, Sjaarda LA, Albert PS, Grantz KL (2015) Previous prelabor or intrapartum cesarean delivery and risk of placenta previa. Am J Obstet Gynecol 212(5):669. doi:10.1016/j.ajog.2015.01.004 (e661–666)

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors appreciate William Murk, PhD. (Department of Chronic Disease Epidemiology, Yale School of Public Health) and Frederick Schatz (Department of Obstetrics and Gynecology, College of Medicine, University of South Florida) for their scientific reading as well as language editing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey

    Sefa Arlier, Sevtap Seyfettinoğlu, EsraSaygili Yilmaz, Hakan Nazik, Cevdet Adıgüzel, Şerif Hürriyetoğlu & Oğuz yücel

  2. Department of Obstetrics and Gynecology, Harran University, Sanliurfa, Turkey

    Eda Eskimez

Authors
  1. Sefa Arlier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sevtap Seyfettinoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. EsraSaygili Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hakan Nazik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cevdet Adıgüzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eda Eskimez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Şerif Hürriyetoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Oğuz yücel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sefa Arlier.

Ethics declarations

Funding

This study was not funded by any foundation or agency.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arlier, S., Seyfettinoğlu, S., Yilmaz, E. et al. Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section. Arch Gynecol Obstet 295, 303–311 (2017). https://doi.org/10.1007/s00404-016-4221-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-016-4221-8

Keywords

Search

Navigation