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Reprod Health. 2017 Nov 2;14(1):143. doi: 10.1186/s12978-017-0388-0.

Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study.

Author information

1
Department of Obstetrics and Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana. manuamah@ug.edu.gh.
2
University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department of Obstetrics and Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana.
4
Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana.
5
Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
6
Department of Obstetrics and Gynecology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

BACKGROUND:

The global increase in Cesarean section rate is associated with short- and long-term complications, including adhesions with potential serious maternal and fetal consequences. This study investigated the prevalence of adhesions and association between adhesions and postoperative complications in a tertiary referral hospital in Accra, Ghana.

METHODS:

In this prospective cohort study, 335 women scheduled for cesarean section at Korle-Bu Teaching Hospital in Accra, Ghana were included from June to December 2015. Presence or absence of adhesions was recorded and the severity of the adhesions was scored using a classification system. Associations between presence and severity of adhesions, postoperative complications, and maternal and infant outcomes at discharge and 6 weeks postpartum were assessed using multivariate logistic and linear regression analysis.

RESULTS:

Of the participating women, 128 (38%) had adhesions and 207 (62%) did not. Prevalence of adhesions increased with history of caesarean section; 2.8% with no CS but may have had an abdominal surgery, 51% with one previous CS, 62% with >1 CS). Adhesions significantly increased operation time (mean 39.2 (±15.1) minutes, absolute adjusted difference with presence of adhesions 9.6 min, 95%CI 6.4-12.8), infant delivery time (mean 5.4 (±4.8) minutes, adjusted difference 2.4 min, 95%CI 1.3-3.4), and blood loss for women with severe adhesions (mean blood loss 418.8 ml (±140.6), adjusted difference 57.6 ml (95%CI 12.1-103.0). No differences for other outcomes were observed.

CONCLUSION:

With cesarean section rates rising globally, intra-abdominal adhesions occur more frequently. Risks of adhesions and associated complications should be considered in counseling patients for cesarean section.

KEYWORDS:

Adhesions; Cesarean sections; Complications; Low- and middle-income countries

PMID:
29096649
PMCID:
PMC5667441
DOI:
10.1186/s12978-017-0388-0
[Indexed for MEDLINE]
Free PMC Article

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