Postoperative Abdominopelvic Adhesions in Repeat Caesarean Section

Background: Postoperative abdominopelvic adhesions pose a major challenge to repeat intra-abdominal surgical procedures with increased risk of injuries to intra-abdominal organs, blood loss and mortality. Repeat abdominal delivery is frequent and the rate is increasing mostly in settings of high parity making data on epidemiology of postoperative abdominopelvic adhesion a significant priority. If underlying abdominopelvic adhesion is predictable preoperatively, appropriate measures will be put in place to reduce the attendant morbidity and mortality that may follow repeat caesarean births in less skilled surgery and preparedness.

Objectives: To determine the prevalence, investigate the predictors, severity and pattern of underlying abdominopelvic adhesions among obstetric population who had repeat caesarean delivery, to explore the risk factors of abdominopelvic adhesions and estimate the associated blood loss morbidity.

Method: This retrospective longitudinal study investigated 194 women who had at least a previous caesarean birth or laparotomy undergoing a repeat caesarean section. Data was collected between 2017 and 2019. Analysis was done using EPI INFO and Instat statistical packages.

Results: One hundred thirty one participants had postoperative abdominopelvic adhesion; an overall prevalence of 67.5% while the values were 60.2%, 80.0% and 90.0% after the first, second and third or more repeat caesarean deliveries respectively.

Socioeconomic status, educational level, number of prior C-section, parity, booking status, previous skin incision and scar type, cadre of primary surgeon, facility of primary surgery significantly related to the prevalence of abdominopelvic adhesions p<.05. Age, body mass index, timing of primary surgery, type of skin healing, blood group did not significantly influence the occurrence of intra-abdominal adhesions p>.05. All the indented and raised skin scars were pigmented and prevalence of underlying adhesions was 100%, 87.3 % and 58.0% for indented, raised and flat skin scars respectively. The non-pigmented and pigmented skin scars respectively had 34.2% and 90.1% underlying abdominopelvic adhesions p=0.03 Blood loss morbidity positively and significantly correlated with the severity of adhesions.

Conclusions: The occurrence, extent, severity and attendant morbidity of intra-abdominal adhesions increase with each additional caesarean delivery. The appearance of the presenting skin incision scar is predictive of underlying adhesions.

Keywords: adhesion, post-caesarean, repeat caesarean, abdominopelvic, intra-abdominal, predictors, risk factors.