An evaluation of the relationship between striae gravidarum and intra-abdominal adhesions in caesarean section

Recurrent cesarean deliveries are associated with intra-abdominal adhesions, and these adhesions affect maternal and neonatal morbidity. The aim of this study was to evaluate the relationship between the severity of striae gravidarum (SG) and intra-abdominal adhesions detected during cesarean section (CS).

In this prospective, case-control study, women undergoing a second CS were divided into three groups according to the severity of SG (group 1 - no SG; group 2 - mild SG; group 3 - moderate to severe SG). Demographic and clinical characteristics, grade of intra-abdominal adhesions, Fitzpatrick skin type (FST), and serum 25-hydroxy vitamin D [25(OH)D] levels were assessed in all groups.

A total of 150 cases were divided into three equal groups. There was no significant difference in body mass index among the groups (p=0.155). Although lower vitamin D levels were observed in group 3 compared to the other groups (p=0.034), the grade of adhesions was not associated with vitamin D level (p=0.281). All of the grade 2-4 adhesions occurred in mild to moderate cases of SG. Intra-abdominal adhesion was absent in 92% of CS (p<0.001) in pregnancies where SG was not detected. No intra-abdominal adhesions were observed in women with FST type 1 and in 80% of cases with type 6 skin, grade 2-4 adhesions were found (p<0.001).

Pregnant women with moderate SG and dark skin are at high-risk of increased incidence of intra-abdominal adhesions in subsequent CS.