Risk factors and predictability of severe post-caesarean section adhesions

Abstract

We aimed to assess risk factors and prediction tools for severe post-CS adhesion formation. Women who underwent CS in a single university-affiliated tertiary medical center were enrolled. Questionnaires assessing adhesions were filled out by the surgeons and were limited to four main anatomical sites: 1. abdomen-to-uterus, 2. uterus-to-bladder, 3. skin-to-fascia, and 4. Other sites. Each site scored between 0-2; sum score range was 0-8. Severe adhesions (score of ≥5) were the primary outcome measure. All cases of CS between January to July 2021 were included and cases with adhesions assessing questionnaires were not completed were excluded. Uni and multivariable logistic regressions were applied to calculate the odds ratio for severe adhesion. Finally, a prediction model was built by a backward variable selection including significant multivariable logistic regression variables and variables with a significant likelihood ratio (LRT) P value. A total of 351 women were included in the study. Women with severe adhesions had significantly higher BMI (26.1 vs. 24.0), had more previous cesarean sections (more than 3 in 12.9% vs. 6.2%), higher rates of gestational diseases (diabetes and Hypertensive disorders) during the current and previous pregnancy (39.8% vs. 23.3% and 31.2% vs. 16.7%, respectively) and a longer previous surgery duration (39.2 vs. 32.2 minutes). In multivariable logistic regressions, previous surgery duration (OR 1.03, CI 1.01-1.04), number of previous CS – two and three or more (OR 3.078, CI 1.66-5.67 and OR 3.32, CI 1.26-8.73, respectively) and gestational disease during the current pregnancy (diabetes and Hypertensive disorders) (OR 2.70, CI 1.39-5.24) had a significant effect on adhesions formation. Furthermore, maternal age was found to have a significant positive contribution to the prediction model (P value LRT < 0.001). The model predicts 75% of severe adhesions. The majority of cases of post-CS adhesions are predictable, based on common risk factors. Our study may contribute to surgeons counseling patients regarding operative risks of adhesionsView Large Image Figure ViewerDownload Hi-res image Download (PPT)