Incidence and sites of pelvic adhesions in women with post-caesarean infertility

Abstract

This cross-sectional study was designed to evaluate the incidences and sites of pelvic adhesions in women with post-caesarean unexplained infertility. This study was conducted at the Tanta University Hospitals in the period from August 1 2015 to July 31 2016. The enrolled patients were assessed by a diagnostic laparoscopy for the presence and sites of abdominal and pelvic adhesions. Pelvic adhesions were found in 98 cases (73.13%) and the remaining 36 cases (26.87%) were free of adhesions. Adhesions were tubal in 55.10%, ovarian in 20.40%, combined tubo-ovarian and omental adhesions in 11.22%, uterine adhesions in 6.12% and a frozen pelvis was found in 7.14%. There was no correlation between the severity of the adhesions and the number of previous caesarean sections (CS). The data of this study led us to conclude that pelvic adhesions are common in patients with unexplained infertility following a caesarean delivery. Tubal and ovarian adhesions to the lateral pelvic wall represent a pathognomonic feature in post-caesarean infertility. Impact Statement What is already known on this subject? Adhesions following a caesarean delivery have been assessed by many studies at the time of the next caesarean delivery. These adhesions have not been studied well in the patients with unexplained infertility. What the results of this study add? The results of this study specify the incidences and the sites of the adhesions which are considered to be pathognomonic for caesarean section. What the implications are of these findings for clinical practice and/or further research? These findings should be applied when the cases of post-caesarean infertility are evaluated in order to shorten the duration and burdens of infertility.

Association between characteristics of previous cesarean delivery and pelvic adhesions: a case-controlled study

“…We investigated the correlation of adhesions to number of cesarean deliveries, where no correlation was found with increased number of CD. This finding agrees with Dawood et al who found no correlation to number of CD [7]. This finding is not in agreement with the results of other studies which found that not only the incidence of adhesions increase with repeat CD but also the density of adhesions increase [3,12].…”

“…Some studies reported that adhesions were increased with increasing number of repeat cesarean sections and led to more surgical difficulties [4]. Other studies reported adhesion formation with a rate of 24.7% after the first cesarean section while higher adhesion formation rates of up to 73.13% after the primary cesarean delivery were reported [5][6][7].…”

Gelatin/Polycaprolactone Electrospun Nanofibrous Membranes: The Effect of Composition and Physicochemical Properties on Postoperative Cardiac Adhesion

“…For example, peritoneal adhesions are commonly observed after abdominal and pelvic surgery, leading to chronic abdominal pain, intestinal obstruction, and female infertility ( Hol et al, 2019 ; Tang et al, 2020 ). And pelvic adhesions resulting from gynecologic surgery may also cause chronic pelvic pain, small bowel obstruction, and female infertility ( Al-Jabri and Tulandi, 2011 ; Dawood and Elgergawy, 2018 ). Besides, tendon adhesions not only cause dysfunction and pain, but also usually require surgical intervention to loosen ( Liu et al, 2013 ; Cai et al, 2021 ).…”

Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-23460 | DOI: 10.14744/tjtes.2020.23460 Boric acid is as effective as hyaluronic acid-based agent in preventing intraabdominal adhesions in a rat model

“…[1,2,4] Pelvic adhesions are held responsible for more than 20% of secondary female infertility and known to increase the risk of ectopic pregnancy. [1,13,14] The most fearsome and life-threatening complication of abdominal adhesions is the intestinal obstruction. More than half of all small bowel obstructions are caused by intra-abdominal adhesions.…”