Fuleswari Mahata1, Suman Poddar2
BACKGROUND
Adhesions after Caesarean section often create difficulties in subsequent
Caesarean deliveries. Intra-operative adhesions result in delayed entry into the
uterine cavity & subsequently baby-delivery, affecting neonatal morbidity; and on
the other side – bladder / bowel injury, wound extensions, difficulty in uterine
wound repair and uterine atony, affecting maternal morbidity. The study was
conducted to comparatively evaluate the extent of intra-operative adhesions in
post and repeat Caesarean cases and their impact over maternal and neonatal
morbidity.
METHODS
The present prospective observational study consecutively recruited equal number
(102) of post and repeat Caesarean cases, elective or emergency, over 10 months.
Primary outcome measure was the presence & nature of intra-operative adhesions,
evaluated with a pre-designed adhesion scoring system. Secondary outcome
measures included baby delivery time, total operating time, neonatal Apgar-1,
incidence of post-partum haemorrhage, bladder / bowel injury and Caesarean
wound extension. P < 0.05 was considered significant for comparative evaluation.
RESULTS
Adhesions were found more significantly in post-Caesarean cases (χ2 = 23.2385,
P < 0.0001), and most were (59.1 %) of filmy type. Adhesion score was
significantly higher in repeat-Caesarean group (P = 0.00694) because adhesions
were mainly dense-type (59.5 %). In either group, however, adhesions between
uterus and bladder were found predominant. In cases with adhesions, post-
Caesarean group shows significantly lesser Apgar-1 score (P < 0.0001), although
median baby-delivery time was found comparable (P = 0.74896). Median total
operating time was more in repeat Caesarean group, though not statistically
significant (P = 0.11876); yet causing significantly more complications (P =
0.0252).
CONCLUSIONS
Intra-operative adhesions were more common in post-Caesarean cases,
significantly affecting neonatal morbidity. Adhesions in repeat-Caesarean cases
were mostly dense, significantly increasing total operating time and thereby
maternal morbidity.
