Prevalence and Prediction of Post-Caesarean Delivery Intra-Abdominal Adhesions in a Rural Tertiary Care Centre
Keywords:
Cesarean section, Adhesions, Postoperative complications, Surgical outcomes, Maternal healthAbstract
Background: Intra-abdominal adhesions are of particular concern but have never been fully screened among women undergoing cesarean sections (CS) globally, with evidence of CS being associated with lower complications in the short- and long-term. These adhesions can result in a variety of maternal and fetal issues such as bowel obstruction, chronic pain, and surgical challenges in the future. The present study attempts to determine the prevalence of intra-abdominal adhesions and association between adhesions and postoperative complications in a rural tertiary care hospital.
Methods: Data was collected from a prospective observational study performed by the authors at R. L Jalappa Hospital and Research Centre, Kolar, from May 2024 to July 2024. Forty-six women scheduled for repeat cesarean delivery, and incidence of at least one prior CS, were included. The preoperative assessment included symptom assessment (e.g., constipation, pelvic pain) and abdominal scar evaluation and ultrasonographic slide tests. A scoring system was used to classify intra-operative adhesions. Descriptive statistics and Chi Square Test were used to correlate preoperative assessments, intraoperative findings with postoperative complications.
Results: In 30 out of the 46 women (65%) intra-abdominal adhesions were found. Adhesions were more common with increasing number of previous CS, with adhesions seen in 45% of the women with one previous CS and 85% of the women with two or more previous CS. The presence of adhesions was significantly correlated with preoperative symptoms including pelvic pain and urinary retention (p ≤ 0.05).
Conclusion: Intra-abdominal adhesion is substantially more common in women undergoing repeated cesarean deliveries. Such adhesions also lead to longer surgical time and blood loss, which further justifies a preoperative prediction to plan surgery carefully in order to prevent complications. As rates of cesarean sections increase globally, the need for not only awareness but also consideration of adhesions in counseling of patients undergoing cesarean delivery is warranted.
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