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

Abstract

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.