Peritoneal adhesions do not increase intra-operative organ injury or adverse neonatal outcomes during a repeated cesarean delivery

Purpose To examine whether the presence of peritoneal adhesions at the second cesarean delivery (CD), attributable to the first CD, are associated with maternal intra-operative organ injury and adverse neonatal outcomes.

A retrospective cohort study was conducted, comparing severe maternal intra-operative organ injury and adverse neonatal outcomes, between women with and without peritoneal adhesions. All women with two CDs during the follow-up period were included. Women with adhesions diagnosed during the first CD, history of other abdominal or pelvic surgery, pelvic infection or pelvic inflammatory disease, endometriosis, uterine Mullerian anomalies and newborns with known chromosomal or structural abnormalities were excluded, resulting in 7925 women. Intra-operative peritoneal organ injury was defined as a composite of bladder injury, ureteral injury, small bowel injury or hysterectomy. The examined adverse neonatal outcomes were low 1 and 5 min Apgar scores, intrapartum death (IPD) and postpartum death (PPD). Multivariate logistic regression was performed.

Peritoneal adhesions at the second CD, attributable to the first CD were diagnosed in 32.6% of patients (n = 2581). The presence of peritoneal adhesions was not found to be independently associated with intra-operative organ injury nor with 5 min Apgar scores, IPD and PPD. Second CDs complicated with adhesions were found to be associated with low (< 7) 1 min Apgar scores (adjusted OR 1.38, CI 1.20–1.58, p < 0.001).

Adhesions attributable to a previous CD do not seem to increase the risk for intra-operative organ injury and adverse neonatal outcomes. These findings may assist in reassuring patients who are facing a second CD. Similar content being viewed by others

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Arch Gynecol Obstet 285:1237–1242. https://doi.org/10.1007/s00404-011-2153-x Funding This study was not funded. Author information Authors and Affiliations Contributions All authors contributed to the study conception and design. AW conceived of the presented idea. AS performed the analytic calculations and wrote the manuscript with input from all authors. ISV verified the analytical methods. All authors helped shape the research and contributed to the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors report no conflict of interest. Ethics statement This article does not contain any studies with human participants or animals performed by any of the authors. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of SUMC institutional review board, # SOR-0146-17. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Saban, A., Shoham-Vardi, I., Yohay, D. et al. Peritoneal adhesions do not increase intra-operative organ injury or adverse neonatal outcomes during a repeated cesarean delivery. Arch Gynecol Obstet 302, 879–886 (2020). https://doi.org/10.1007/s00404-020-05676-2 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-020-05676-2