946: Predictive value of striae gravidarum score for pelvic adhesions at repeat cesarean delivery

Abstract

Previous abdominal operations might cause severe pelvic adhesions which can complicate cesarean delivery (CD) procedures. The present study aimed to evaluate the possible predictive value of striae gravidarum (SG) assessment on the pelvic adhesions formation. The current study was a cross-sectional study conducted in a tertiary university hospital between November 2016 and March 2018. All women scheduled for elective CD were included if they had pat least previous one CD. We excluded women with history of PID, endometriosis, previous abdomino-pelvic surgery and those with history of wound site infections. Then, preoperative evaluation of SG severity using Davey score which is validated scoring systems was done on the examination bed. Patients with no/mild striae (score 0-2) were classified as group (I) and women with severe striae (score 3-8) were classified as group (II). During surgery, pelvic adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the difference in the rate of pelvic adhesions between both groups The study included 300 women in the final analysis; group I included 114 women and group II included 186 women. The mean age of the study participants was 28.43 ± 4.56 years. The mean parity was 3.22 ± 1.26 and the mean gestational age at inclusion was 37.26 ± 1.13 weeks. Eighty women (26.7%) were delivered by 3 CS or more. No statistical significant difference regarding the baseline characteristics of both study groups. Regarding presence of pelvic adhesions during CD, about 90% of women with severe striae versus 82.5% of women with no/mild striae were found to have adhesions with statistical significant difference (p=0.035). Dense adhesions were significantly present in severe striae group (57.4%) versus (41.5%) in no/mild striae group (p=0.022). The mean Davey score in women with group (II) was significantly higher than group (I) (4.25±3.36 vs. 2.95±3.09, p=0.03). Nair's score was positive moderately correlated with Davey score (r=0.541, p=0.016). According to the results of multivariate regression analysis, Davey score > 2 was the only variable associated with increased risk of pelvic adhesions (p=0.010). Therefore, it is considered as significant predictor of pelvic adhesions Assessment of SG status of a patient with a previous CD using Davey score might help predict pelvic adhesions status before planning a new surgery