Friday, May 06, 2011

A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics

NASUH U. DOGAN1, SEVAL A. HAKTANKACMAZ1, SELEN DOGAN2, OZLENEN OZKAN3, HATICE CELIK1, OZLEM G. ERYILMAZ1, MELIKE DOGANAY1, CAVIDAN GULERMAN1Article first published online: 16 MAR 2011Keywords: Intraabdominal adhesion; repeat cesarean delivery; hypertrophic scar

DOI: 10.1111/j.1600-0412.2011.01080.x
© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2011 Nordic Federation of Societies of Obstetrics and Gynecology


Objective. To evaluate association between scar characteristics and intraabdominal adhesions at repeat cesarean delivery. Design. A prospective, cross-sectional study. Setting. Tertiary Government Maternity Training Hospital in Ankara, Turkey. Population. 295 pregnant women with at least one prior cesarean delivery. Methods. All women were at least 36 weeks pregnant. Appearance of previous cesarean delivery scars was categorized into three groups – flat, depressed and elevated. Pigmentation status was also noted (non-pigmented or pigmented). Main Outcome Measures. Intraoperatively detected adhesions, evaluated and classified into three groups (no adhesion, filmy adhesion and dense adhesion groups) by a modified Nair's classification. Results. Elevated scars had significantly more dense adhesion formation than depressed ones (31.4 vs. 12.7%, p=0.02). No difference was found for dense adhesions when depressed and flat scars were compared (12.7 vs. 6.8%, p=0.124). Of flat scars, 93.2% were free of dense adhesions. Pigmented scars had more dense adhesions than non-pigmented (26.6 vs. 9.3%, p<0.01). Using logistic regression analysis scar length, scar width and appearance of scar (flat or non-flat) were directly related to adhesion formation. Conclusion. There is an association between scar type and adhesions, particularly for hypertrophic scars and dense adhesions.

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