title: Adhesions at repeat cesarean delivery: is there a personal impact?
abstract: OBJECTIVE
  The rise in the rate of cesarean deliveries highlights complications related to adhesion formation. This study evaluated whether the incidence and severity of adhesions secondary to repeat cesarean deliveries are a consequence of repeated surgeries or due to an individual's propensity to develop adhesions.
  
  
  METHODS
  A retrospective chart review was conducted for 160 patients who had more than two repeat cesarean deliveries in a single teaching hospital. Data regarding intra-abdominal adhesions were collected. The severity, location, density and amount of adhesions were evaluated based on standard operative reports. Adhesion progression in subsequent cesarean deliveries was evaluated for each individual patient.
  
  
  RESULTS
  69/160 (43 %) patients developed significant adhesions following the primary cesarean delivery. Of these, 46 (67 %) had significant adhesions at the second surgery. Of the 91 (57 %) patients, who did not develop significant adhesions after the primary cesarean delivery, 34 (37 %) had significant adhesions at the third surgery. A patient presenting with significant adhesions at her second cesarean had a 1.88-fold risk for significant adhesions at her third cesarean (95 % CI 1.3-2.7).
  
  
  CONCLUSIONS
  Our results suggest that adhesion development might be influenced by individual factors more than by the number of cesarean deliveries.
authors: Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tschernihovsky St., Kfar Saba, Israel.
authors: Einat Haikin
authors: EH
authors: Herzberger
authors: Hila
authors: H
authors: Alon
authors: Anat
authors: A
authors: Hershko-Klement
authors: Yael
authors: Y
authors: Ganor-Paz
authors: Moshe D
authors: MD
authors: Fejgin
authors: Tal
authors: T
authors: Biron-Shental
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D017604:Cesarean Section, Repeat / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000150:complications* / Q000453:epidemiology; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology*