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Arch Gynecol Obstet. 2017 Feb;295(2):303-311. doi: 10.1007/s00404-016-4221-8. Epub 2016 Oct 21.

Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section.

Author information

1
Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey. sefaarlier@gmail.com.
2
Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.
3
Department of Obstetrics and Gynecology, Harran University, Sanliurfa, Turkey.

Abstract

PURPOSE OF INVESTIGATION:

We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity.

MATERIALS AND METHODS:

We analyzed intra-abdominal adhesions of 672 patients.

RESULTS:

Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively.

CONCLUSIONS:

Emergency operations and adhesions increased complications.

KEYWORDS:

Intraoperative complication; Morbidity; Postoperative complication; Repeat cesarean section; Tissue adhesion

PMID:
27770246
DOI:
10.1007/s00404-016-4221-8
[Indexed for MEDLINE]

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