American Journal of Obstetrics & Gynecology
Volume 201, Issue 1 , Pages 56.e1-56.e6, July 2009

Adhesion development and morbidity after repeat cesarean delivery

Presented at the 57th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, Chicago, IL, May 2-6, 2009.

  • Togas Tulandi, MD, MHCM

      Affiliations

    • Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
    • ,
  • Mohammed Agdi, MD

      Affiliations

    • Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
    • ,
  • Afsoon Zarei, MD

      Affiliations

    • Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
    • ,
  • Louise Miner, MD

      Affiliations

    • Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
    • ,
  • Vanja Sikirica, PharmD

      Affiliations

    • Ethicon Inc., Somerville, NJ

Received 27 November 2008; received in revised form 20 April 2009; accepted 22 April 2009.

Objective

The purpose of this study was to evaluate the development and implications of intraabdominal adhesions after repeat cesarean section delivery (CS).

Study Design

We reviewed the charts of 1283 women who underwent repeat CS and 203 other women who underwent primary CS. Primary outcome measures were incidence and extent of adhesions, incision-to-delivery interval, and operating time.

Results

No adhesions were found in primary CS. Compared with those women with a second CS (24.4%), significantly more women had adhesions after 3 CSs (42.8%; 95% confidence interval [CI], 0.84-0.99). Compared with a first CS (7.7 ± 0.3 minutes), the delivery time was significantly longer at subsequent CSs (second CS, 9.4 ± 0.1 minutes; 95% CI, 1-2; third CS, 10.6 ± 0.3 minutes; 95% CI, 2-4; ≥ 4 CSs, 10.4 ± 0.1 minutes; 95% CI, 1-2). However, complication rates in those women with ≥ 2 CSs were comparable with primary CS.

Conclusion

Increased adhesion development and a longer time to delivery were found with each subsequent CS.

Key words: adhesion, cesarean section delivery, delivery time, operating time, repeat cesarean section delivery

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 Funded by an educational Grant from Ethicon Inc., Somerville, NJ.

 Reprints not available from the authors.

 Cite this article as: Tulandi T, Agdi M, Zarei A, et al. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009;201:56.e1-6.

PII: S0002-9378(09)00433-5

doi:10.1016/j.ajog.2009.04.039

American Journal of Obstetrics & Gynecology
Volume 201, Issue 1 , Pages 56.e1-56.e6, July 2009

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