Vol 94, No 1 (2023)
Research paper
Published online: 2022-10-26

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Association between characteristics of previous cesarean delivery and pelvic adhesions: a case-controlled study

Ayman S. Dawood1, Adel E. Elgergawy1, Abdelghaffar S. Dawood1
Pubmed: 36378128
Ginekol Pol 2023;94(1):51-56.


Objectives: To assess the correlation of previous cesarean delivery characteristics to pelvic adhesions in infertile patients. Material and methods: This Case-controlled study was conducted in the period from January 2018 to December 2020 at Tanta University. All patients (222) presenting with post-cesarean infertility who underwent diagnostic laparoscopy were included in the study. According to presence of adhesions during laparoscopy, two groups were allocated. Characteristics of previous cesarean delivery were assessed in patients with or without adhesions. Results: There were significant differences between both groups regarding type of CS, shape of skin scar, parietal peritoneal closure, and postoperative complications of the prior CS between both groups. Independent predictors of adhesions were age [OR: 1.43 (1.15–1.77); p = 0.001], BMI [OR: 0.76 (0.61–0.95); p = 0.02], emergency CS [OR: 7.74 (1.61–37.19); p = 0.01], parietal peritoneal closure [OR: 0.06 (0.01–0.24); p = 0.001]. Conclusions: Post-cesarean adhesions were correlated to age, BMI, emergency CD, double layer closure, and closure of peritoneum and to postoperative complications. No correlation to duration of infertility or number of cesarean sections.

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  1. Walfisch A, Beloosesky R, Shrim A, et al. Adhesion prevention after cesarean delivery: evidence, and lack of it. Am J Obstet Gynecol. 2014; 211(5): 446–452.
  2. Elgergawy AE, Elhalwagy AE, Salem HA, et al. Outcome of Laparoscopic Adhesiolysis in Infertile Patients with Pelvic Adhesions Following Cesarean Delivery: A Randomized Clinical Trial. J Gynecol Obstet Hum Reprod. 2021 May 1. ; 50(5): 101969.
  3. Morales KJ, Gordon MC, Bates GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007; 196(5): 461.e1–461.e6.
  4. Rossouw JN, Hall D, Harvey J. Time between skin incision and delivery during cesarean. Int J Gynaecol Obstet. 2013; 121(1): 82–85.
  5. Poole JH. Adhesions following cesarean delivery: a review of their occurrence, consequences and preventative management using adhesion barriers. Womens Health (Lond). 2013; 9(5): 467–477.
  6. Moro F, Mavrelos D, Pateman K, et al. Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. Ultrasound Obstet Gynecol. 2015; 45(2): 223–228.
  7. Dawood AS, Elgergawy AE. Incidence and sites of pelvic adhesions in women with post-caesarean infertility. J Obstet Gynaecol. 2018; 38(8): 1158–1163.
  8. Buţureanu SA, Buţureanu TA. Pathophysiology of adhesions. Chirurgia (Bucharest, Romania: 1990). 2014 May 1;109(3):293-8. .
  9. Awonuga AO, Fletcher NM, Saed GM, et al. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci. 2011; 18(12): 1166–1185.
  10. Shenhav S, Grin L, Kapustian V, et al. Quantifying the effects of postcesarean adhesions on incision to delivery time. J Matern Fetal Neonatal Med. 2019; 32(15): 2500–2505.
  11. Hinterleitner L, Kiss H, Ott J. The impact of Cesarean section on female fertility: a narrative review. Clin Exp Obstet Gynecol. 2021 Aug 11. ; 48(4): 781–6.
  12. Tulandi T, Agdi M, Zarei A, et al. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009; 201(1): 56.e1–56.e6.
  13. Stark M, Hoyme UB, Stubert B, et al. Post-cesarean adhesions--are they a unique entity? J Matern Fetal Neonatal Med. 2008; 21(8): 513–516.
  14. Doherty DA, Magann EF, Chauhan SP, et al. Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes. Aust N Z J Obstet Gynaecol. 2008; 48(3): 286–291.
  15. Salim R, Kadan Y, Nachum Z, et al. Abdominal scar characteristics as a predictor of intra-abdominal adhesions at repeat cesarean delivery. Fertil Steril. 2008; 90(6): 2324–2327.
  16. Kinay T, Savran Uc, Ramoglu S, et al. Maternal obesity and intra-abdominal adhesion formation at cesarean delivery. J Matern Fetal Neonatal Med. 2020 Jun. ; 30: 1–6.
  17. Herzberger EH, Alon H, Hershko-Klement A, et al. Adhesions at repeat cesarean delivery: is there a personal impact? Arch Gynecol Obstet. 2015; 292(4): 813–818.
  18. Joergensen SL, Settnes A. Post-Cesarean Adhesion Syndrome. J Gynecol Surg. 2019 Oct 1. ; 35(5): 314–7.
  19. Cheong YC, Premkumar G, Metwally M, et al. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol. 2009; 147(1): 3–8.
  20. Chanrachakul B, Hamontri S, Herabutya Y. A randomized comparison of postcesarean pain between closure and nonclosure of peritoneum. Eur J Obstet Gynecol Reprod Biol. 2002; 101(1): 31–35.
  21. Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril. 2008 Nov 1. ; 90(5): S144–9.
  22. CAESAR Study Collaborative Group. Caesarean section surgical techniques: a randomised factorial trial (CAESAR). BJOG. 2010 Oct. ; 117(11): 1366–76.
  23. Qiong-qiong NI. Clinical Analysis of 113 Cases with Peritoneal Adhesion After Cesarean Section. Med Recap. ; 2008: 5.
  25. Seyam E, Ibrahim EM, Youseff AM, et al. Laparoscopic Management of Adhesions Developed after Peritoneal Nonclosure in Primary Cesarean Section Delivery. Obstet Gynecol Int. 2018; 2018: 6901764.
  26. Sholapurkar SL. Can the practice of nonclosure of visceral and parietal peritoneum during cesarean delivery be justified? Am J Obstet Gynecol. 2015; 212(4): 550.
  27. Kahyaoglu I, Kayikcioglu F, Kinay T, et al. Abdominal scar characteristics: do they predict intra-abdominal adhesions with repeat cesarean deliveries? J Obstet Gynaecol Res. 2014; 40: 1643–1648.
  28. Stocker LJ, Glazebrook JE, Cheong YC. Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy? Fertil Steril. 2014; 101(2): 501–505.
  29. Pergialiotis V, Frountzas M, Siotos C, et al. Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2017; 30(4): 486–491.
  30. Taylan E, Akdemir A, Ergenoglu AM, et al. Can We Predict the Presence and Severity of Intra-Abdominal Adhesions before Cesarean Delivery. Gynecol Obstet Invest. 2017; 82(6): 521–526.
  31. Chrelias G, Pergialiotis V, Oikonomou M, et al. Correlation of cesarean section scar characteristics with intra-abdominal adhesions–A prospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2019 Mar 1. ; 234: e115.
  32. Soltan MH, Al Nu, Khashoggi T, et al. Sequelae of repeat cesarean sections. Int J Gynaecol Obstet. 1996; 52: 127–132.
  33. Herzberger EH, Alon H, Hershko-Klement A, et al. Adhesions at repeat cesarean delivery: is there a personal impact?. Arch Gynecol Obstet. 2015 Oct. ; 292(4): 813–8.