Incidence of Adhesion Formation after Previous Caesarean Section
Background - The optimal technique for performing caesarean section (CS) with respect to minimising postoperative adhesions has not been determined.
Objectives - To estimate incidence of adhesions after cesarean section and to investigate the prevalence and location of pelvic adhesions in women with a history of CS.
Material and Methods - A total of 390 patients who underwent delivery by CS at at 1-st Clinical Medical Center in Baku,Azerbaijan between January 2013 and January 2015 were included in the study. We studied 30 cases of primary CS and 360 cases of repeat CS (first repeat, second or third repeat CS). Using 3 adhesion scoring system: peritoneal adhesion index (PAI), adhesion scoring system by Tulandi and general classification the prevalence, extent, and consistency of adhesions were evaluated prospectively.
Results - The total number of patients with adhesions differed by a reliable prevalence in the prospective group, where the total number of patients examined with a history of CS was 60 patients among whom 17 (28.3%) women with adhesions were identified. In the retrospective group the number of identified patients with adhesions was 31 (10.3%) among 300 patients. İn our research no adhesions were found in women who underwent primary CS. Adhesions mainly were found between the uterus and the bladder, and between the uterus and omentum. The results of this study has showed, that the incidence of adhesions was much higher after repeated cesarean section. From 10.3% - to 28.3% after first cesarean section and from 21.1% – to 69.2% after repeated cesarean section.
Keywords - Cesarean section, adhesion, classification.