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Abdominal scar characteristics as a predictor of intra-abdominal adhesions at repeat cesarean section

      Objective

      Abdominal scar characteristics (ASC) and intra-abdominal adhesions (IAA) are both heeling processes that form with individual variation. We aimed to investigate whether ASC could predict the degree of IAA found at repeat cesarean section.

      Study design

      Pregnant women with at least one previous cesarean section (CS), and who were delivered abdominally, were included. ASC that were noted pre-operatively included the length, width, color, position, and height or depth of the scar. Intra-operatively, we noted IAA of the omentum to the abdominal muscles or to the uterus, peritoneum to the uterus, abdominal muscles to the uterus and frozen pelvis. Women were categorized as to have thick vascular adhesions, light adhesions or no adhesions. Maternal age, body mass index, previous abdominal operations, number of previous CS, length of time since the last CS, gestational age at birth, maternal chronic diseases were noted. Student's t-test and Fisher-exact tests were used. P < 0.05 was considered significant.

      Results

      Of 67 included women, 18 had thick vascular IAA. Of these, 5 had a frozen pelvis. Forty-nine women had light or no adhesions. Seven women (39%) with thick adhesions and 7 women (14.3%) without adhesions, had a depressed scar (p = 0.04, 95% C.I. 1.1-13.2). Of the 5 women with a frozen pelvis, 4 had a depressed scar compared to one with a non-depressed scar (p = 0.006, 95% C.I. 2.1-206). None of the other scar characteristics were correlated with the degree of IAA nor the other parameters studied.

      Conclusion

      A depressed abdominal scar of a previous cesarean section is correlated with the degree of intra-abdominal adhesions. The number of previous cesarean sections was not associated with the degree of intra-abdominal adhesions. Recognizing women at risk for IAA may aid for proper preoperative preparations.