title: Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section.
abstract: OBJECTIVE
  To investigate the prevalence and location of pelvic adhesions in women with a history of Cesarean section and to identify risk factors for their formation and symptoms associated with their presence.
  
  
  METHODS
  This was a prospective observational study of women in whom one or more Cesarean sections had been performed > 12 months previously and who attended for a gynecological ultrasound examination. In all women, both transvaginal and transabdominal scans were performed in order to identify the presence of pelvic adhesions. Medical and surgical history was recorded and a structured questionnaire was used to enquire about any history of pelvic pain and urinary symptoms.
  
  
  RESULTS
  A total of 308 women were recruited into the study. On ultrasound examination, 139 (45.1% (95% CI, 39.7-50.7%)) women showed evidence of adhesions within the pelvis. Adhesions in the vesicouterine pouch were the most common and were found in a total of 79 (25.6% (95% CI, 20.7-30.5%)) women. In women with a history of no surgery other than Cesarean section(s) (n = 220), an increasing number of Cesarean sections (odds ratio (OR) 3.4 (95% CI, 2.1-5.5)) and a postoperative wound infection (OR 11.7 (95% CI, 3.5-39.5)) increased the likelihood of adhesions developing in the anterior pelvic compartment. There was a significant association between the presence of anterior compartment adhesions and chronic pelvic pain. Multivariable logistic regression analysis identified anterior abdominal wall adhesions (OR 2.4 (95% CI, 1.0-5.9)) and any adhesions present on ultrasound scan (OR 2.6 (95% CI, 1.2-5.7)) as independent predictors of chronic pelvic pain.
  
  
  CONCLUSIONS
  Pelvic adhesions are present in more than a third of women with a history of Cesarean section and they are associated with chronic pelvic pain.
authors.affiliation: Department of Obstetrics and Gynaecology, University College Hospital, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Moro
authors.forename: D
authors.initials: D
authors.lastname: Mavrelos
authors.forename: K
authors.initials: K
authors.lastname: Pateman
authors.forename: T
authors.initials: T
authors.lastname: Holland
authors.forename: W L
authors.initials: WL
authors.lastname: Hoo
authors.forename: D
authors.initials: D
authors.lastname: Jurkovic
mesh_terms: D000328:Adult; D000368:Aged; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology*; D010388:Pelvis / Q000000981:diagnostic imaging*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000267:Tissue Adhesions / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014463:Ultrasonography; D055815:Young Adult
keywords: Cesarean section; surgical adhesions; ultrasound