Abstract
Purpose
The rise in the rate of cesarean deliveries highlights complications related to adhesion formation. This study evaluated whether the incidence and severity of adhesions secondary to repeat cesarean deliveries are a consequence of repeated surgeries or due to an individual’s propensity to develop adhesions.
Methods
A retrospective chart review was conducted for 160 patients who had more than two repeat cesarean deliveries in a single teaching hospital. Data regarding intra-abdominal adhesions were collected. The severity, location, density and amount of adhesions were evaluated based on standard operative reports. Adhesion progression in subsequent cesarean deliveries was evaluated for each individual patient.
Results
69/160 (43 %) patients developed significant adhesions following the primary cesarean delivery. Of these, 46 (67 %) had significant adhesions at the second surgery. Of the 91 (57 %) patients, who did not develop significant adhesions after the primary cesarean delivery, 34 (37 %) had significant adhesions at the third surgery. A patient presenting with significant adhesions at her second cesarean had a 1.88-fold risk for significant adhesions at her third cesarean (95 % CI 1.3–2.7).
Conclusions
Our results suggest that adhesion development might be influenced by individual factors more than by the number of cesarean deliveries.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bates GW, Shomento S (2011) Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol 205:S19–S24
Tulandi T, Agdi M, Zarei A, Miner L, Silirica V (2009) Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 201(56):e1–e6
Stark M, Hoyme UB, Stubert B, Kieback D, DiRenzo GC (2008) Post-cesarean adhesions—are they a unique entity? J Mat Fetal Neonatal Med 21:513–516
Lyell DJ (2011) Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol 205:S11–S18
Hamel KJ (2007) Incidence of adhesions at repeat cesarean delivery. Am J Obstet Gynecol 196:e31–e32
Morales KJ, Gordon MC, Bates GW (2007) Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 196:461.e1–461.e6
Doherty DA, Magann EF, Hahuhan SP, O’boyle AL, Bush JM, Morrison JC (2008) Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes. Aust New Z J Obstet Gynaecol 48:286–291
Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL (2005) Risk factors for bladder injury during cesarean delivery. Obstet Gynecol 105:156–160
Gungorduk K, Asicioglu O, Celikkol O, Sudolmus S, Ark C (2010) Iatrogenic bladder injuries during caesarean delivery: a case control study. Obstet Gynecol 30:667–670
Alpay Z, Sead GM, Diamond MP (2008) Postoperative adhesions: from formation to prevention. Sem Reprod Med 26:313–321
Salim R, Kadan Y, Nachum Z, Edelstein S, Shalev E (2008) Abdominal scar characteristics as a predictor of intra-abdominal adhesions at repeat cesarean delivery. Fertil Steril 90:2324–2327
Tulandi T, Al-Sannan B, Akbar G, Zeigler C, Miner L (2011) Prospective study of intraabdominal adhesions among women of different races with or without keloids. Am J Obstet Gynecol 204(132):e1–e4
Stocker LJ, Glazebrook JE, Cheong YC (2014) Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy? Fertil Steril 101:501–505
Bamigboye AA, Hofmeyer GJ (2005) Non-closure of peritoneal surfaces at caesarean section-a systematic review. S Afr Med J 95:123–126
Huchon C, Raiffort C, Chis C, Messaoudi F, Jacqiemot MC, Panel P (2005) Caesarean section: closure or non-closure of peritoneum? A randomized trial of postoperative morbidity. Gynecol Obstet Fertil 33:745–749
Berghella V, Baxter JK, Chauhan SP (2005) Evidence-based surgery for cesarean delivery. Am J Obstet Gynecol 193:1607–1617
Lyell DJ, Caughey AB, Hu E et al (2012) Rectus muscle and visceral peritoneum closure at cesarean delivery and intraabdominal adhesions. Am J Obstet Gynecol 206:515.e1–515.e5
Blumenfeld Y, Caughey A, El-Sayed Y, Daniels K, Lyell D (2010) Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions. BJOG 117:690–694
Kapustain V, Anteby EY, Gdalevich M, Shenhav S, Lavie O, Gemer O (2012) Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study. Am J Obstet Gynecol 206(56):e1–e4
Chapa HO, Venegas G, Vanduyne CP, Antonetti AG, Sandate JP, Silver L (2011) Peritoneal adhesion prevention at cesarean section: an analysis of the effectiveness of an absorbable adhesion barrier. J Reprod Med 56(3–4):103–109
Uygur D, Tapisiz OL, Mungan T (2005) Multiple repeat cesarean sections: maternal and neonatal outcomes. Int J Gynaecol Obst 89:284–285
Gedikbasi A, Akyol A, Bingol B et al (2010) Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases. Taiwan J Obstet Gynecol 49:425–431
Lyell DJ, Caughey AB, Emily Hu, Daniels K (2005) Peritoneum closure at primary cesarean delivery and adhesions. Obstet Gynecol 106:275–280
Malvasi A, Tinelli A, Gustapane S, Mazzone E, Cavallotti C, Stark M, Bettocchi S (2011) Surgical technique to avoid bladder flap formation during cesarean section. G Chir 32(11–2):498–503
Myers SA, Bennett TL (2005) Incidence of significant adhesions at repeat cesarean section and the relationship to method of prior peritoneal closure. J Reprod Med 50:659–662
Conflict of interest
The authors do not have any conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Herzberger, E.H., Alon, H., Hershko-Klement, A. et al. Adhesions at repeat cesarean delivery: is there a personal impact?. Arch Gynecol Obstet 292, 813–818 (2015). https://doi.org/10.1007/s00404-015-3718-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-015-3718-x