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Adhesions following cesarean delivery: a review of their occurrence, consequences and preventative management using
1Queens University of Charlotte, Blair College of Health, Presbyterian School of Nursing, 1900 Selwyn Avenue, Charlotte, NC 28274, USA. poolejh@queens.edu
Insights
Postoperative adhesions are common after cesarean delivery (CD), increasing risks with repeat procedures. Adhesion barriers show promise in reducing formation and complications, but more research is needed.
Area of Science:
- Obstetrics and Gynecology
- Surgical Complications
- Adhesion Science
Background:
- Postoperative adhesions frequently occur after cesarean delivery (CD), with incidence rising with each subsequent procedure.
- Adhesions complicate repeat CDs, increasing operative time, delivery time, and the risk of bladder injury.
Purpose of the Study:
- To review the occurrence and consequences of postoperative adhesions after cesarean delivery.
- To overview clinical data on adhesion prevention using barriers in the context of cesarean delivery.
Main Methods:
- Comprehensive literature review of studies on postoperative adhesions following cesarean delivery.
- Analysis of published clinical data on the efficacy of adhesion barriers for prevention.
Main Results:
- Two small, nonrandomized studies indicated that absorbable anti-adhesion barriers significantly reduced adhesion formation.
- Use of adhesion barriers was associated with a shorter time to delivery in repeat cesarean deliveries compared to no barrier use.
Conclusions:
- Clinical data on adhesion prevention strategies for cesarean delivery are limited.
- There is a significant need for well-controlled, randomized clinical studies to investigate adhesion prevention in the labor and delivery setting.
Abstract:
The objective of this article is to provide a comprehensive review of the occurrence and consequences of postoperative adhesions following cesarean delivery (CD), and an overview of the published clinical data on prevention in this setting using adhesion barriers. Adhesions occur frequently after CD and the incidence increases with each subsequent CD. Repeat CDs are complicated by adhesions, which increase operating time, time to delivery and risk of bladder injury. Clinical data on the efficacy of adhesion prevention strategies specific to the setting of CD are limited. Two small, nonrandomized studies found that the use of absorbable anti-adhesion barriers was associated with a significant reduction in adhesion formation and a shorter time to delivery at repeat CD, compared with no barrier use. Implications for practice and research are discussed. There is a significant need for well-controlled, randomized clinical studies investigating adhesion prevention in the labor and delivery setting.
