Abdominal scar characteristics: do they predict intra-abdominal adhesions with repeat cesarean deliveries?

The aim of this study was to evaluate the relation between abdominal scar characteristics and the severity of intra-abdominal adhesions with repeat cesarean deliveries.

A total of 208 women with at least one previous cesarean delivery at or beyond 37 weeks of gestation who were admitted for repeat cesarean delivery were enrolled in this study. Scars were categorized as depressed, flat or elevated according to their appearance, and hyperpigmented or the same color as the surrounding skin according to their pigmentation status. Intraoperative adhesions were graded according to the modified Nair's classification and categorized as no adhesion, filmy or dense adhesions.

No significant difference was found between women with or without adhesions regarding age, body mass index, gestational week at delivery, number of previous cesarean deliveries or the duration since the last cesarean delivery. Women with depressed scars had more intra-abdominal adhesions than women with flat or elevated abdominal scars (P = 0.013). There was no significant difference in the incidence of hyperpigmented and non-pigmented scars between women with or without adhesions (39.4% vs 41.3% and 60.6% vs 58.7%, respectively) (P > 0.05). Scar width was significantly larger in patients with intra-abdominal adhesions than in patients without adhesions (3.6 ± 1.1 vs 3.2 ± 0.9) (P = 0.003), whereas scar length did not differ significantly (15.2 ± 1.3 vs 15.1 ± 2.1) (P > 0.005).

There is a relation between depressed abdominal scars and intra-abdominal adhesions, whereas pigmentation status does not differ between women with or without adhesions.