Can We Predict the Presence and Severity of Intra-Abdominal Adhesions before Cesarean Delivery

Abstract

Aims: The study aimed to investigate whether we can predict the presence and severity of intra-abdominal adhesions before cesarean delivery using patient history, symptoms, and abdominal skin scar characteristics. Methods: In this prospective study, 143 pregnant women with history of previous abdominal surgery were included and they delivered by cesarean. Preoperative abdominal scar characteristics and symptoms as well as intraoperative abdominal adhesions were evaluated using the Manchester Scar Scale, a symptomatology questionnaire and the More Comprehensive Adhesion Scoring Method, respectively. Results: Patients with adhesions (n = 98) and without adhesions (n = 45) had similar baseline characteristics. In the adhesion group, abdominal scar scoring parameters were significantly increased. However, there was no significant correlation among total scar score, adhesion score, and symptom score. Conclusion: Despite the availability of many proposed methods, accurate prediction of the severity of surgery-related adhesions is beyond our current abilities. Therefore, as healthcare providers, obstetricians should avoid unnecessary use of the cesarean approach. This approach is more effective, beneficial, realizable, and reasonable than the prediction of surgery-related adhesions.

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery

“…In a systemic review of 29 trials published by Bamigboye et al [18] limited and inconsistent evidence was found regarding the relationship between adhesion formation and closure versus non-closure, while the non-closure technique was associated with shorter surgical time [18] Neither of the demographic factors in this study was found to be associated with the severity of adhesions. This is similar to the results found by Taylan et al [2] Stocker et al [11] and Çim et al [19]. The current study attempted to apply two skin markers together, each of which had previously been taken by other researchers as separate factors.…”

“…Cesarean section (CS) is one of the most common operations done in the obstetric ward, and its usage is rapidly rising [1]. In the United States, the rate of Cesarean delivery during the last twenty-five years has risen to 30% of all deliveries; and in the last ten years, it has become the fifth-most-frequent surgical procedure performed in the U.S [2]. According to the annual statistical report published by the Iraqi Ministry of Health in 2017, the rate of Cesarean section deliveries in Iraq was 33.2% [3].…”

“…Intraabdominal adhesions are known complications of CS, leading to patient morbidity and creating problems during the next CS, including difficulty in gaining entrance into the abdominal cavity and injury to the pelvic and abdominal organs [6]. The anticipation of adhesions is essential as the surgeon chooses the place of operation, and it plays an important role in the pre-operative assessment aimed at preventing intraoperative complications [2]. Stretch-lines, or striae gravidarum, are one of the physiological changes that occur in the skin of pregnant women.…”

Subcutaneous tissue stiffness of cesarean incision scar by elastography as a predictor of intra‐abdominal adhesions

“…Besides, Taylan et al evaluated the skin scar characteristics of pregnant women with any kind of previous abdominal surgery at CS. 24 Although the abdominal scar score was higher in the adhesion group, no correlation was found between the scar score and the adhesion score. When compared to our results, we found a positive correlation between the subcutaneous scar tissue stiffness and intra-abdominal adhesions and subcutaneous tissue stiffness ≥36.5 had 74.4% sensitivity and 40.5% specificity for the prediction of moderate or severe adhesions.…”

“…Besides, Taylan et al . evaluated the skin scar characteristics of pregnant women with any kind of previous abdominal surgery at CS 24 . Although the abdominal scar score was higher in the adhesion group, no correlation was found between the scar score and the adhesion score.…”