Cesarean Section Scar Charactersitics as a Preoperative Predictor of Intra-Abdominal Adhesions

Objective: Is to study the relationship of the intra-abdominal adhesions to the type of skin scar characters (flat and non-flat) in women who had two previous cesarean sections. Method: This study includes 138 women of at least 36 weeks pregnant with two previous cesarean deliveries under-going cesarean delivery. The skin scar of the previous cesarean delivery is inspected preoperatively and categorized into flat or non-flat scar (elevated and depressed scars). Intra-operatively the detected adhesions are categorized into no adhesions, filmy adhesions and dense adhesions. Results: Out of 138 women included in this study 67 (48.6%) have flat scar and 71 (51.4%) have non-flat scar (elevated or depressed). 70.4% of non-flat scars had dense adhesions while 29.6 of flat scars had dense adhesions, (OR 5.22; 95% CI 2.53-10.77, p=0.000). In comparison to women who have flat scar, subjects who have depressed scar are found to be significantly associated with dense adhesions (53.3 vs. 46.7%) (OR 17.52; 95% CI 4.75-64.72, p=.000), followed by elevated scar (55.3 vs. 44.7%) (OR 3.16; 95% CI 1.43-6.99, p=.004). The least scar character associated with dense adhesion is the flat scar. Conclusion: Women with non-flat scar (depressed and elevated) who have undergone two previous cesarean deliveries are found to be significantly associated with dense intra-abdominal adhesions.