Role of peripheral inflammatory biomarkers, transforming growth factor-beta and interleukin 6 in predicting peritoneal adhesions following repeat cesarean delivery

Ir J Med Sci. 2022 Dec;191(6):2697-2704. doi: 10.1007/s11845-021-02878-8. Epub 2022 Jan 6.


Background: Repeat cesarean deliveries (CDs) pose a risk in the development of intra-abdominal adhesions.

Aim: We aimed to examine the incidence and severity of adhesions in repeat CDs using a specific scoring system and assess the predictive power of the pre-operative value of transforming growth factor (TGF)-β and interleukin (IL)-6 with selected peripheral inflammatory biomarkers (PIBs) in the prediction of adhesion formation.

Methods: This prospective study enrolled 91 pregnant women at term, who had previously undergone at least one or more scheduled CDs. PIBs, namely C-reactive protein, white blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index, TGF-β, and IL-6 were studied according to the presence and location of adhesions.

Results: There was a significant difference only in the variables of the number of CDs, post-operative adhesion index (PAI) score, IL-6, and TGF-β on the presence of adhesion (p < 0.05). The linear regression model revealed that the effect of the number of CDs, PAI score, and IL-6 values on TGF-β was significant (p < 0.05). The effect of the PAI score on TGF-β was higher than that of IL-6. As a reciprocal relationship, the effect of the TGF-β value on the PAI score was also higher than that of IL-6.

Conclusion: In patients with a history of repeat CDs, the preoperative determination of TGF-β seems to be an important independent predictor of POA. The adverse events due to post-operative adhesion caused by repeat CDs can be overcome by detecting high-risk patients with a comprehensive assessment and individualized intervention integrated into overall patient management.

Keywords: Cesarean delivery; IL-6; Peripheral inflammatory biomarkers; Post-operative adhesions; TGF-β.

MeSH terms

  • Biomarkers
  • Female
  • Humans
  • Interleukin-6* / metabolism
  • Pregnancy
  • Prospective Studies
  • Tissue Adhesions / etiology
  • Transforming Growth Factor beta*
  • Transforming Growth Factors


  • Interleukin-6
  • Transforming Growth Factor beta
  • 4-iodobenzenesulfonamide
  • Biomarkers
  • Transforming Growth Factors