Scar Charactersitics as a Preoperative Predictor of Intra-Abdominal Adhesions

Objective: Is to study the relationship of the intraabdominal adhesions to the type of skin scar characters (flat and non-flat) in women who had two previous cesarean sections. Method: This study includes 138 women of at least 36 weeks pregnant with two previous cesarean deliveries undergoing cesarean delivery. The skin scar of the previous cesarean delivery is inspected preoperatively and categorized into flat or non-flat scar (elevated and depressed scars). Intraoperatively the detected adhesions are categorized into no adhesions, filmy adhesions and dense adhesions. Results: Out of 138 women included in this study 67 (48.6%) have flat scar and 71 (51.4%) have non-flat scar (elevated or depressed). 70.4% of non-flat scars had dense adhesions while 29.6 of flat scars had dense adhesions, (OR 5.22; 95% CI 2.53-10.77, p=0.000). In comparison to women who have flat scar, subjects who have depressed scar are found to be significantly associated with dense adhesions (53.3 vs. 46.7%) (OR 17.52; 95% CI 4.75-64.72, p=.000), followed by elevated scar (55.3 vs. 44.7%) (OR 3.16; 95% CI 1.43-6.99, p=.004). The least scar character associated with dense adhesion is the flat scar. Conclusion: Women with non-flat scar (depressed and elevated) who have undergone two previous cesarean deliveries are found to be significantly associated with dense intraabdominal adhesions.

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