Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

Awonuga, Awoniyi O.; Fletcher, N.M.; Saed, Ghassan M.; Diamond, Michael P.

doi:10.1177/1933719111414206

Cited by 91 publications

(76 citation statements)

References 159 publications

(248 reference statements)

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“…The incidence of adhesion development increases with the number of CS performed is shown in many studies. 10 The most common adhesions found in the group are between bladder and uterus and also between uterus and omentum.…”

Section: Discussionmentioning

confidence: 99%

A study of intra-operative maternal morbidity after repeating caesarean section

Somani¹,

Sudhir²,

Somani³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.

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Section: Discussionmentioning

confidence: 99%

A study of intra-operative maternal morbidity after repeating caesarean section

Somani¹,

Sudhir²,

Somani³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…Specifically, abdominopelvic adhesions occur in 24% to 83% following cesarean and 55% to 100% after gynecological operations [14][15][16][17] and are associated with potential devastating complications such as infertility, 18 ectopic pregnancy, 19 bowel obstruction, 20 abdominal and pelvic pain, 21 and difficult reoperation. 22 The pathogenesis of oxidative stress-triggered postoperative adhesion development remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Advances in the Pathogenesis of Adhesion Development: The Role of Oxidative Stress

et al. 2014

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Over the past several years, there has been increasing recognition that pathogenesis of adhesion development includes significant contributions of hypoxia induced at the site of surgery, the resulting oxidative stress, and the subsequent free radical production. Mitochondrial dysfunction generated by surgically induced tissue hypoxia and inflammation can lead to the production of reactive oxygen and nitrogen species as well as antioxidant enzymes such as superoxide dismutase, catalase, and glutathione peroxidase which when optimal have the potential to abrogate mitochondrial dysfunction and oxidative stress, preventing the cascade of events leading to the development of adhesions in injured peritoneum. There is a significant cross talk between the several processes leading to whether or not adhesions would eventually develop. Several of these processes present avenues for the development of measures that can help in abrogating adhesion formation or reformation after intraabdominal surgery.

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“…Несмотря на изобилие предложен-ных к настоящему времени средств и рекомен-даций для предотвращения послеоперационного спайкообразования, надежного и действенного средства пока не найдено [2]. Большинство при-меняемых в настоящее время методов профилак-тики спайкообразования недостаточно ýффек-тивны [3]. Одним из перспективных направлений решения ýтой проблемы является использование лекарственных средств, обладающих общим воз-действием на патогенетические звенья спаечного процесса и, прежде всего, на функциональную активность фибробластов.…”

Section: Introductionunclassified