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

Abstract

Objective: To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery.

Design: Prospective cohort study.

Setting: Delivery suite of a university-based obstetrics unit.

Patient(s): Pregnant women with at least one previous cesarean delivery and who delivered abdominally.

Intervention(s): Abdominal scars were divided preoperatively into flat and non-flat scars (which included elevated and depressed scars). Intraoperatively we noted intra-abdominal adhesions 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 having filmy adhesions, dense vascular adhesions (including women with a frozen pelvis), or no adhesions.

Main outcome measure(s): The incidence and severity of intra-abdominal adhesions.

Result(s): Of 107 women enrolled into this trial, 61 (57%) had no adhesions, 17 (16%) had filmy adhesions, and 29 (27%) had dense adhesions. Of all the abdominal scar characteristics studied, only a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions. Of 22 women with a depressed scar, 5 (23%) had a frozen pelvis, compared with 2 (2.4%) of 85 women who did not have a depressed scar (odds ratio 12.2, 95% confidence interval 2.2-68.3).

Conclusion: A depressed abdominal scar of a previous cesarean delivery is correlated with the incidence and severity of intra-abdominal adhesions.