To determine the association, if any, between obstetrical and surgical factors and adhesion formation after a primary cesarean delivery (CD).METHODS:
This is retrospective cohort of patients at a single institution who underwent a primary CD between 2008 and 2010, with a repeat CD by 12/2013. At the time of each CD, an adhesion assessment form was completed, as per the standard of care. The form evaluates the character of adhesions (none [score 0], filmy [score 1], dense [score 2]) in five locations (bowel, fascia to uterus, omentum to uterus, omentum to fascia, bladder to uterus). Patients with an adhesion score greater than or equal to 4 were compared to those patients with fewer adhesions. 38 possible obstetrical and surgical predictors of adhesions were entered into a univariable analysis; then, all significant variables were entered into an adjusted model to determine independent predictors of adhesion formation.RESULTS:
851 patients met inclusion criteria for the study. After multivariable analyses, patients with peritoneal closure (OR 0.25, 95% CI 0.14–0.43, P<.001) or rectus muscle closure (OR 0.57, 95% CI 0.37–0.89, P<.01) at primary CD are less likely to have an adhesion score greater than or equal to 4. No difference was seen with adhesion barrier use (OR 1.19, 95% CI 0.76–1.89, P<.45).CONCLUSION:
Our study suggests that peritoneal and/or rectus muscle closure at the time of CD should be routinely performed, as these are safe, cost-effective surgical techniques that reduce adhesion formation and may decrease long term risks of operative morbidity.