Factors Influencing Adhesion Formation After Primary Cesarean Delivery [26C]

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To determine the association, if any, between obstetrical and surgical factors and adhesion formation after a primary cesarean delivery (CD).


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.


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).


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.

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