Adhesion Prevention After Cesarean Delivery: Evidence, and Lack of It

Am J Obstet Gynecol. 2014 Nov;211(5):446-52. doi: 10.1016/j.ajog.2014.05.027. Epub 2014 May 22.


In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery.

Keywords: adhesion barriers; pelvic adhesions; peritoneal closure; repeat cesarean section.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Abdominal Wound Closure Techniques*
  • Cesarean Section / methods*
  • Cesarean Section, Repeat / methods
  • Female
  • Humans
  • Peritoneal Diseases / prevention & control*
  • Peritoneum / surgery*
  • Pregnancy
  • Tissue Adhesions / prevention & control
  • Uterine Diseases / prevention & control*