Maternal obesity and intra-abdominal adhesion formation at cesarean delivery

The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery.

Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (<30 kg/m² and ≥30 kg/m²). The intra-abdominal adhesion incidence and the scar characteristics of the groups were compared.

Intra-abdominal adhesions were more common in women ≥30 kg/m² than in those <30 kg/m² (OR 2.0, 95% CI 1.1-3.6). BMI upon cesarean delivery (32.6 ± 6.2 kg/m² vs. 30.5 ± 4.8 kg/m², p = .018) and pre-pregnancy BMI (27.9 ± 6.8 kg/m² vs. 25.7 ± 5.2 kg/m², p = .026) were higher in women with dense adhesions than in those with either filmy or no adhesions. The omentum was the most adherent tissue, and the omental adhesion rate was also higher in women ≥30 kg/m² than in those <30 kg/m² (39.6% vs. 23.7%, p = .016). When the scar characteristics were compared, it was observed that the hyperpigmented scar rate was significantly lower (17.8% vs. 39.6%, p = .001) in women ≥30 kg/m² with intra-abdominal adhesions (16.7% vs. 35.4%, p = .005).

Intra-abdominal adhesion formation following cesarean delivery is more common in obese women.