947: Are skin scar characteristics associated with intra-abdominal adhesions at repeat cesarean delivery?

Abstract

The current study aims to evaluate the association between skin scar characteristics and intra- abdominal adhesions at repeat cesarean delivery (CD). The current study was a prospective cross-sectional study carried out in a tertiary Maternity hospital between November 2016 and March 2018. Three hundred women with at least one prior CD and scheduled for repeat elective CD were included. Preoperative evaluation of the skin scar characteristics was performed including scar appearance (flat-depressed-elevated), scar pigmentation (hyper-pigmented or non-pigmented), scar length and width. During repeat CS, intra-abdominal adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the rate of pelvic adhesions among study participants and its association with the different scar characteristics. Regarding presence of intra-abdominal adhesions, no difference between women with flat scar versus non-flat scars regarding presence of adhesions (p=0.148). However, dense adhesions were significantly present in women with non-flat scar (71.7%) versus (46.1%) in the other group (p=0.001). no difference between women with hyper- pigmented versus non-pigmented scars regarding presence of adhesions (p=0.448). Correlation analysis shows that Nair's score was positive moderately CS scar length (r=0.575, p=0.032), however not correlated with CS scar width (r= 0.137, p=0.082). Using logistic regression analysis scar length, scar width and scar pigmentation were not related to adhesions formation. Only the non-flat scars were significant predictor to the occurrence of intra-abdominal adhesions (p<0.001) There is an association between CS scar appearance and formation of intra-abdominal adhesions, particularly for elevated and depressed scars