A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics

Acta Obstet Gynecol Scand. 2011 May;90(5):531-4. doi: 10.1111/j.1600-0412.2011.01080.x. Epub 2011 Mar 16.


Objective: To evaluate association between scar characteristics and intraabdominal adhesions at repeat cesarean delivery.

Design: A prospective, cross-sectional study.

Setting: Tertiary Government Maternity Training Hospital in Ankara, Turkey.

Population: 295 pregnant women with at least one prior cesarean delivery.

Methods: All women were at least 36 weeks pregnant. Appearance of previous cesarean delivery scars was categorized into three groups - flat, depressed and elevated. Pigmentation status was also noted (non-pigmented or pigmented).

Main outcome measures: Intraoperatively detected adhesions, evaluated and classified into three groups (no adhesion, filmy adhesion and dense adhesion groups) by a modified Nair's classification.

Results: Elevated scars had significantly more dense adhesion formation than depressed ones (31.4 vs. 12.7%, p=0.02). No difference was found for dense adhesions when depressed and flat scars were compared (12.7 vs. 6.8%, p=0.124). Of flat scars, 93.2% were free of dense adhesions. Pigmented scars had more dense adhesions than non-pigmented (26.6 vs. 9.3%, p<0.01). Using logistic regression analysis scar length, scar width and appearance of scar (flat or non-flat) were directly related to adhesion formation.

Conclusion: There is an association between scar type and adhesions, particularly for hypertrophic scars and dense adhesions.

MeSH terms

  • Abdominal Cavity / pathology*
  • Adult
  • Cesarean Section, Repeat*
  • Cicatrix / pathology*
  • Cicatrix, Hypertrophic / pathology
  • Cross-Sectional Studies
  • Female
  • Hospitals, Public
  • Humans
  • Logistic Models
  • Predictive Value of Tests
  • Pregnancy
  • Prospective Studies
  • Tissue Adhesions / pathology*
  • Turkey