Background: The cesarean section rate has increased in the last decade, a significant risk factor for intra-abdominal adhesion. This study investigated the diagnostic accuracy of cesarean scar indicators for intra-abdominal adhesions in pregnant women. Methods: This cross-sectional study was conducted on pregnant women with a previous cesarean section who were candidates for elective repeated cesarean section. We gathered demographic information, including age, number of prior cesarean sections, past medical and surgical history, the time since the last operation, and the inspection of the cesarean incision. The evidence of pelvic adhesion was calculated in the operating room by the Manchester scar scale, and intra-abdominal adhesions were graded using a modified Nair's classification. The data were analyzed by proper tests. Results: One hundred pregnant women were included in the study and divided into two groups with high and low incision indices. In the low incision index group, 82.1% had a history of one cesarean section, and 1.3% had three or more, and in the group with a high incision index, 54.5% had a history of one cesarean section, and 13.6% had three times or more (P < 0.05). Women with a high incision index had a higher adhesion rate than the other group (P < 0.001). The sensitivity and specificity of the scar index in the diagnosis of adhesions were 57.48% and 92.30%, respectively. Conclusions: It is challenging to accurately predict the severity of adhesions resulting from cesarean section, but it is urged to prevent an unnecessary cesarean section.