title: [Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study].
abstract: OBJECTIVE
  To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery.
  
  
  METHODS
  Prospective cohort study including 151pregnant women with at least one previous cesarean delivery and who delivered abdominally in the department of obstetrics and gynaecology of Farhat Hached teaching hospital-Sousse-Tunisia, during 6 months. Abdominal scar characteristics were studied. The main outcome measure(s) were the incidence and severity of intra-abdominal adhesions. Statistical analysis was performed using SPSS 18.0.
  
  
  RESULTS
  Of 151 women enrolled into this trial, 111 (73.5%) had adhesions, 57 (37.8%) had dense adhesions. Of all the abdominal scar characteristics studied, a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions and frozen pelvis if compared of women who did not have a depressed scar (P<10(-4) ; RR=7.6; IC=2.98-19.45). A number of previous cesarean section equal or more than 2 was also correlated with an increased incidence of severe intra-abdominal adhesions and frozen pelvis if compared with women who had only one previous cesarean section (P=0.002; RR=2.53; IC=1.16-5.56).
  
  
  CONCLUSIONS
  A depressed abdominal scar of a previous cesarean delivery and a number of previous cesarean sections are significantly correlated with the incidence and severity of intra-abdominal adhesions.
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie. Electronic address: khlifiabj@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Khlifi
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: S
authors.initials: S
authors.lastname: Meddeb
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Kouira
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Boukadida
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: F
authors.initials: F
authors.lastname: Hachani
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: S
authors.initials: S
authors.lastname: Chachia
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: S
authors.initials: S
authors.lastname: Hidar
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Bibi
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Khairi
authors.affiliation: Service de gynécologie obstétrique, CHU Farhat Hached de Sousse, rue Mohamed-Karoui, CP 4000 Sousse, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Essaidi
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects* / Q000706:statistics & numerical data; D002921:Cicatrix / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010388:Pelvis / Q000473:pathology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D014416:Tunisia / Q000453:epidemiology
keywords: Abdominal scar characteristics; Abdominal surgery; Accouchement par césarienne; Adhesions; Adhérence; Caractéristiques de la cicatrice abdominale; Cesarean delivery; Chirurgie abdominale; Prevention; Prévention