Risk Factors Contributing to Adhesive Disease Following Primary Cesarean Section: A Cross-Sectional Study

Cesarean section is one of the most commonly performed obstetric surgeries worldwide, with rising rates of repeat procedures. Intra-abdominal adhesions are a frequent complication following prior cesarean deliveries and can complicate subsequent surgeries, leading to increased operative time, blood loss, and risk of visceral injury. Understanding the distribution, severity, and risk factors for adhesion formation is crucial for improving surgical outcomes. This study aimed to evaluate the distributive pattern of adhesions in women undergoing repeat cesarean section, identify associated demographic and clinical risk factors, and assess the impact of adhesions on operative parameters and postoperative outcomes.

A prospective, observational cross-sectional study was conducted at Sree Balaji Medical College and Hospital, Chennai, including 104 women scheduled for repeat cesarean delivery. Adhesions were assessed intraoperatively based on site, severity, and size using the Tulandi and Lyell composite adhesion scoring system. Maternal demographic and clinical data, including age, socioeconomic status, comorbidities, type, and indication of previous cesarean, were recorded. Operative outcomes, such as duration of surgery, estimated blood loss, and postoperative hospital stay, were analyzed. Statistical analysis included chi-square tests for categorical variables and independent t-tests for continuous variables, with p < 0.05 considered significant.

Adhesions were present in 31.7% (33/104) of participants. Emergency cesarean, low socioeconomic status, gestational diabetes, and certain previous CS indications (cervical dystocia, second stage arrest, failed induction with PROM) were significantly associated with adhesion formation (p < 0.05). Women with adhesions experienced significantly higher mean blood loss (490.3 ± 127.4 vs 433.9 ± 120.6 mL, p = 0.03) and longer operative time (67.3 ± 10.9 vs 45.9 ± 7.6 min, p < 0.001).  Conclusion: Intra-abdominal adhesions are common in repeat cesarean sections, particularly following emergency procedures and in women with specific comorbidities. Adhesions significantly impact surgical outcomes, highlighting the importance of careful surgical planning and preventive strategies in women undergoing repeat cesarean deliveries.