Closure vs. nonclosure of the peritoneum at cesarean delivery.
OBJECTIVE
To compare the frequency and severity of celiac adhesions following cesarean sections performed with and without closure of the parietal and visceral peritoneum.


METHODS
A retrospective cohort study involved 612 women who underwent their second lower-segment transverse cesarean section.


RESULTS
Nonclosure of the parietal peritoneum at the time of the first cesarean section was associated with significantly more visceral adhesions than closure (16.2% vs. 8.1%; P=0.003), and closure of the visceral peritoneum had a similar effect (16.1% vs. 6.7%; P=0.02). However, the difference in rates of severe adhesions was not statistically significant (12.9% vs. 17.6%; P=0.12). After controlling for confounding variables, it was found that closure of the parietal peritoneum reduced the rate of visceral adhesions 2.7-fold. Trial of labor before and fever after surgery increased the risk of severe adhesions 6.1-fold and 5.6-fold, respectively.


CONCLUSIONS
Nonclosure of the peritoneum at primary cesarean section is associated with a significantly increased risk of visceral adhesions.
Yiyang
Zhu
Z
Department of Obstetrics and Gynecology, Taizhou Hospital, Wenzhou Medical College, Lin Hai City, Zhejiang Province, China. yiangz@sohu.com
Qunxi
Cai
C
Weiling
Wu
W
D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010532:Peritoneal Diseases / Q000209:etiology* / Q000473:pathology; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology