Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

Abstract

Background The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. Methods This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey’s scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair’s scoring system was used to evaluate intraperitoneal adhesions. Results The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey’s and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001). Conclusion Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

Accuracy of Cesarean Scar Indicators for Predicting Intra-abdominal Adhesions

“…Elprince et al reported a strong correlation between the abdominal scar index and abdominal striae in predicting intra-abdominal adhesions. It is contrary to the present study, possibly because the striae factor is not discussed in the present study (10).…”

Prevalence and risk factor of postoperative adhesions following repeated cesarean section: A prospective cohort study

“…Conflicting results are present regarding this issue. Some studies declared that hypopigmented and depressed scars were associated with dense intraperitoneal adhesions, 35,36 while others reported the contrary 37,38 …”

“…Some studies declared that hypopigmented and depressed scars were associated with dense intraperitoneal adhesions, 35,36 while others the contrary. 37,38 The effect of age on adhesion formation was unclear. Intestinal obstruction occurred after an appendectomy at age 20-39 and less than 60 years.…”

Effectiveness of various methods of manual scar therapy

“…In many cases as consequences of deep dermal defects appear hypoesthesia, hyperalgesia around the injured area, and functional limitations. 4,5 The normal wound healing process is a strictly controlled state of balance between the process of disintegration of the structure of the damaged tissue and the repair consisting in the synthesis and formation of a new, correct one. Mediators, blood cells, extracellular matrix cells, and parenchymal cells are involved in the process.…”

“…Despite recent advances in surgical techniques and scar therapies, there is no dependable strategy to manage postoperative adhesions. In many cases as consequences of deep dermal defects appear hypoesthesia, hyperalgesia around the injured area, and functional limitations 4,5 …”