English

Abstract

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 (χ 2 = 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, postCaesarean 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. KEYWORDS Intra-Operative Adhesions, Maternal and Neonatal Morbidity