Abdominal scar characteristics as a predictor of intra-abdominal adhesions at repeat cesarean delivery

Abdominal and pelvic adhesions: Possible role of leiomyomas and skin scar anomaly in profiling high risk patients

“…In patients without PAS, we found 13.46% of adhesions, slightly higher than 10.4% reported by Menzies et al [7] but lower than 28% by Weibel et al [29] and 47% by Shokeir et al [19]. The adhesions frequency of our series is close to 44.45% reported by Weibel et al [29], working on 752 autopsies conducted in women and men, and to 43% found by Salim et al [27], studying adhesions in relation to abdominal scar in repeat cesarean delivery. But it is somewhat higher than that of 35.5% found by Brill et al [20] in women undergoing laparoscopy.…”

“…Sub Saharan African environmental situation, particularly related to surgical practice [23,24] and other factors such as postoperative infections [24], sexually transmitted infections [25] etc., might predict high prevalence of adhesions. In addition, some conditions such as leiomyomas and keloids, whose prevalence has been found higher in black skinned people [26], share many characteristics with adhesions [27]. Since one of the implicated factors of these is the fibroblast activity, it can be speculated that the prevalence of adhesions traces the same pattern.…”

Classification of intra-abdominal adhesions after cesarean delivery

“…Besides studies listed on Table 1, all adhesion scoring systems were non-site-specific or unclearly described [13][14][15][16][17][18]. There were three randomized studies (Table 2).…”

“…Of three prospective non-randomized studies, Salim et al used a site-specific adhesion scoring system, and severity of adhesions was divided into light filmy or dense vascular adhesions [16]. However, detailed description of sitespecific adhesions was not provided.…”

“…We included studies where the adhesions were evaluated prospectively with site-specific adhesion scoring systems (Table 1) [5,11,12]. Studies with unclear evaluation of adhesions (Table 2) [13][14][15][16][17][18] and retrospective studies (Tables 3 and 4) [19][20][21][22][23][24][25] were excluded.…”