Adhesions in repeat caesarean sections: prevalence, predictive factors, and surgical outcomes

Aastha Jain; Ramesh Chandra; Manaswi Agarwal; Sabiya Mansoori; Manohari

doi:10.18203/2320-1770.ijrcog20251577

Authors

Aastha Jain Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, Rajasthan, India https://orcid.org/0009-0003-5867-7671
Ramesh Chandra Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, Rajasthan, India https://orcid.org/0009-0008-5749-5522
Manaswi Agarwal Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, Rajasthan, India
Sabiya Mansoori Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, Rajasthan, India
Manohari Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20251577

Keywords:

Caesarean section, Maternal risk factors, Visceral injury, Operative time, Surgical morbidity, Adhesion formation

Abstract

Background: Adhesion formation is a common sequela of repeat caesarean sections (CS), associated with increased surgical complexity and morbidity. This study aimed to identify maternal and surgical predictors of adhesion formation and to assess its intraoperative and postoperative consequences.

Methods: This cross-sectional cohort study was conducted at Sawai Mansingh Medical College, Jaipur, from June to December 2024. A total of 100 women undergoing repeat CS were included. Data on maternal demographics, surgical history, intraoperative findings, and postoperative outcomes were collected. Adhesions were graded as mild, moderate, or dense. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26, with p value <0.05 considered statistically significant.

Results: Adhesions were present in 35% of cases 15% mild, 11% moderate, and 9% dense. Significant predictors of adhesion formation included higher body mass index (BMI) (p=0.003), greater number of previous CS (p=0.0212), and higher parity. Adhesions were significantly associated with increased operative time (mean 60.56±8.46 minutes for dense adhesions), greater hemoglobin drop (1.10±0.25 g/dl versus 0.65±0.26 g/dl, p<0.001), higher rates of intraoperative blood transfusion (66.7% versus 7.7%, p<0.001), and visceral injury (44.4% versus 0%, p<0.001). Duration of hospital stay did not differ significantly between groups.

Conclusions: Adhesion formation in repeat CS is significantly associated with maternal risk factors and adversely impacts surgical outcomes. Anticipating adhesions through risk assessment and applying meticulous surgical techniques are essential to minimize complications.

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References

World Health Organization. Caesarean section rates continue to rise, amid growing inequalities in access. 2021. Available at: https://www.who.int/news/item/ 16-06-2021-caesarean-section-rates-continue-to-rise-amidgrowing-inequalities-in-access. Accessed on 12 April 2025.

World Health Organization. WHO statement on caesarean section rates. 2015. Available at: https://www.who.int/publications/i/item/WHORHR-15.02. Accessed on 12 April 2025.

Morales KJ, Gordon MC, Bates GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007;196(5):461.e1-e6. DOI: https://doi.org/10.1016/j.ajog.2006.12.017

Zia S, Rafique M. Intra-operative complications increase with successive number of cesarean sections: Myth or fact? Obstet Gynecol Sci. 2014;57(3):187-90. DOI: https://doi.org/10.5468/ogs.2014.57.3.187

Cook J, Jarvis S, Knight M, Dhanjal M. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG. 2013;120(1):85-91. DOI: https://doi.org/10.1111/1471-0528.12010

Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205(3):262.e1-e8. DOI: https://doi.org/10.1016/j.ajog.2011.06.035

Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations. Reprod Sci. 2011;18(12):1166-85. DOI: https://doi.org/10.1177/1933719111414206

Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol. 2009;201(1):56.e1-e6. DOI: https://doi.org/10.1016/j.ajog.2009.04.039

Greenberg MB, Daniels K, Blumenfeld YJ, Caughey AB, Lyell DJ. Do adhesions at repeat cesarean delay delivery of the newborn? Am J Obstet Gynecol. 2011;205(4):380.e1-e5. DOI: https://doi.org/10.1016/j.ajog.2011.06.088

Diamond MP, Wexner SD, diZereg GS, Korell M, Zmora O, Van Goor H, et al. Adhesion prevention and reduction: current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov. 2010;17(3):183-8. DOI: https://doi.org/10.1177/1553350610379869

Badu E, Ghosh J, Adjei G. Prevalence of adhesions and their impact on cesarean section outcomes in a tertiary hospital in Ghana. Reprod Health. 2021;18(1):1-7.

Dawood M, Sadiq S, Arif N. Impact of previous cesarean sections on the formation of adhesions and surgical outcomes: A systematic review. J Obstet Gynaecol. 2023;43(2):138-46.

El-Nashar IM, Abbas AM, Zaki CG. Effect of multiple repeat cesarean sections on intra-abdominal adhesions. Egypt J Hosp Med. 2022;89:4500-6. DOI: https://doi.org/10.21608/ejhm.2022.258480

Ghosh S, Chatterjee S, Roy T. Obesity and adhesion formation: A retrospective study of 250 cesarean deliveries. J Clin Surg. 2022;50(2):68-72.

Morales CL, Andrade V, González JA. Adhesion formation after cesarean sections: A retrospective study of 500 cases. J Obstet Gynecol. 2024;43(4):345-51.