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

Abstract

Objectives: The aim of the present study has been to examine skin scar characteristics and striae gravidarum, considering the reliability of each for predicting adhesions in repeat Caesarean sections. Material and methods: A cross-sectional study was done over a period of two years. One hundred pregnant women were invited to participate in the study. Preoperatively, abdominal scar features (according to the scar's appearance) and stria gravidarum were both recorded. Then, at the time of surgery, intraabdominal adhesions were graded according to the modified Nair's classification. Results: Among the skin markers, abdominal scar width (p = 0.001), depressed scar (p = 0.002) and striae colour grading (p = 0.0183) were found to have significant associations with intraabdominal adhesions; yet all were of low validity. Conclusions: Despite growing interest in the use of skin markers in the prediction of intraabdominal adhesions at the time of repeat CS, the present study demonstrates that these markers may not be reliable.

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

“…In contention with the current study, there was no difference in peritoneal adhesions in women with or without striae (14,15). However, another study reported higher rates of intraperitoneal adhesions in women with no or mild striae than those with severe striae (67.3%, 65.9%, and 36.3%, respectively) (13).…”

“…This was thought to arise from variability in transforming growth factor-beta, which plays an essential role in the formation of hypertrophic scars as well as intraperitoneal adhesions (13). Scar width and appearance showed signi cant association with dense intraperitoneal adhesions (p-value 0.001, and 0.002 respectively) (15). Depressed hypopigmented scars were also associated with adhesions, which were assumed to arise from the inward traction from the adhesion bands (17,18).…”

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

“…The results were not uniform; different markers such as a depressed or elevated scar, hyperpigmentation or hypopigmentation of the scar, scar width or scar lengths were all found to be predictive of adhesions in distinct studies. [5][6][7][8] These different results might be due to the fact that peritoneal healing starts all over the damaged surface as opposed to skin, which heals from the edges. 22 In 2017, a meta-analysis of the observational studies revealed that only depressed scars were statistically associated with intra-abdominal adhesions.…”

“…[5][6][7][8][9][10] Evaluation of the previous cesarean scar features (flat, depressed, elevated), scar pigmentation (non-pigmentation, hyperpigmentation), scar width and scar length have yielded conflicting results. [5][6][7][8] The absence of the free movement of the uterine anterior wall against the abdominal wall (sliding sign) on ultrasound is another sign of adhesions. 9,10 However, the interpretation of this technique needs experience to reach a high rate of intra-observer and inter-observer reproducibility.…”

“…Predicting adhesion formations before surgery is important to reduce the intraoperative complications and related morbidities. Therefore, many studies have been conducted to predict adhesions before a repeated CS 5–10 . Evaluation of the previous cesarean scar features (flat, depressed, elevated), scar pigmentation (non‐pigmentation, hyperpigmentation), scar width and scar length have yielded conflicting results 5–8 .…”