title: Closure vs. nonclosure of the peritoneum at cesarean delivery.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Taizhou Hospital, Wenzhou Medical College, Lin Hai City, Zhejiang Province, China. yiangz@sohu.com
authors.forename: Zhu
authors.initials: Z
authors.lastname: Yiyang
authors.forename: Cai
authors.initials: C
authors.lastname: Qunxi
authors.forename: Wu
authors.initials: W
authors.lastname: Weiling
mesh_terms: 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